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It records the occurrence of an automobile collision, the resulting bodily injuries, and the absence of any automobile insurance or other coverage that would pay benefits. 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That my name is   of  \n`  \n___________________________________________________  \n___________________________________________________  \n2. That I was involved in an automobile collision on    \n[date]  \nat   .  \n[location]  \n3. As a result of that collision, I suffered bodily injuries.  \n4. That I did not own an automobile on the date of this accident.  \n5. That no member of the household (resident relative) in which I reside owns an automobile.  \n6. That I have no automobile insurance or any other insurance which would pay any benefits to cover my bodily injuries.  \n7. That I was not within the course of my employment at the time of the accident.  \n8. I have no Uninsured/Under Insured Motorist Coverage  \n[Signature]  \nSworn to before me this   day of  \n  , 20   \n_______________________________  \nNotary Public  \nAny person who, knowingly and with intent to injure, defraud, or deceive any insurance company files a statement of claim containing any false or misleading information commits insurance fraud, punishable by law.","cbCaiteEkg0rN3rK","https://ap.wps.com/l/cbCaiteEkg0rN3rK","pdf",13219,"English","# Claim Details\n## Parties and Location\n## Accident Information\n## Injury and Insurance Statements\n## Employment Status\n## Signatures and Notary Acknowledgment","[{\"question\":\"What does the affidavit confirm about automobile ownership?\",\"answer\":\"It states that the claimant did not own an automobile on the accident date and that no household member owns an automobile in which the claimant resides.\"},{\"question\":\"What insurance coverage does the affidavit declare as unavailable?\",\"answer\":\"It declares that the claimant has no automobile insurance and no other insurance that would pay benefits to cover bodily injuries, including no Uninsured/Under Insured Motorist Coverage.\"},{\"question\":\"What is the purpose of the notary section and the fraud warning?\",\"answer\":\"The notary section provides sworn acknowledgment before a Notary Public. The warning states that knowingly submitting false or misleading information to an insurance company constitutes insurance fraud punishable by law.\"}]","Affidavit of No Insurance Coverage - Auto Insurance Claim | PDF",1788509307]