Fill and Sign the New Jersey Law Forms Including Statutory References and Brief

- 1 - (Name of Plaintiff) (Address) (Phone) SUPERIOR COURT OF NEW JERSEY , CHANCERY DIVISION Plaintiff FAMILY PART, COUNTYvs.CASE NO. ,AFFIDAVIT OF INSURANCE COVERAGE Defendant )))))))))))STATE OF NEW JERSEY))SSCOUNTY OF )I, , being of full age and duly sworn, according to law, upon oath, depose and say: 1. I am the Plaintiff in this case and am filing this Affidavit in support of my Complaint for Divorce.2. The following is a complete list of all known insurance coverage of the parties, including but not limited to life, health, automobile, and homeowner's insurance.Name of Insured: Type of Ins (circle):Life/Health/Auto/Home/OtherInsurance Co. Name: Address: Phone: Fax: Policy Number: Who Else Covered: (If Applicable) Policy Term: Name Beneficiary(ies): Name of Insured: Type of Ins (circle):Life/Health/Auto/Home/OtherInsurance Co. Name: Address: Phone: Fax: Policy Number: Who Else Covered: (If Applicable) Policy Term: Name Beneficiary(ies): - 2 - Name of Insured: Type of Ins (circle):Life/Health/Auto/Home/OtherInsurance Co. Name: Address: Phone: Fax: Policy Number: Who Else Covered: (If Applicable) Policy Term: Name Beneficiary(ies): Name of Insured: Type of Ins (circle):Life/Health/Auto/Home/OtherInsurance Co. Name: Address: Phone: Fax: Policy Number: Who Else Covered: (If Applicable) Policy Term: Name Beneficiary(ies): I hereby specify that any and all cancellations or modifications made to these or any other insurance policies within the last ninety (90) days are listed below: All insurance identified in this affidavit shall be maintained pending further order of the court.Dated: By:________________________________ Plaintiff Sworn and Subscribed to before me, t his d ay o f , 2 0 . _________________________________Notary Public of the State of New JerseyMy commission expires on .