Statement of Fact Form
When a person intends to register a car, apply for insurance or for any graduate/undergraduate program and in other such conditions it is mandatory for the applicant to fill a statement of facts form which provides accurate and factually correct information about an applicant. The statement of Fact form contains all the personal and other related details of an individual.
Sample Statement of Fact Form
Personal details:
Full name: _______________________________. Security Number ____________
Address: ____________________City _____________State: ___________Zip: _______
Phone: ________________Email: _________________Fax: ________________________
Age: ________________ No. of Family Members: ________________
Date of Birth: ________________
Employer: ________________________________________________________________
Policy No: ________________ Insured: ________________
Insurance start date: ________________ Insurance End date: ________________
Underwriter: ________________
Insured business: ________________
Other Details (tick ‘yes’ or ‘no):
Are there any ongoing legal disputes or disputes related to contracts? Yes No
Have you ever been declared bankrupt or insolvent? Yes No
Have you suffered from any major illnesses in the recent past? Yes No
Category: Statement Forms
