I certify that I, or the firm, company, or corporation I am authorized to represent, am the legal owner within the meaning of California Vehicle Code. S.No, Agency, Form Number, Form Title, Status Code, Content Type, Form URL.If any of the statements you make on the form are false, your insurance and claim may be voided. Three things to remember when filling out a Proof of Loss form. The notice must have a form you can fill out and send back to request the extension. IN THE SUPREME COURT OF CALIFORNIA AMERICAN FINANCIAL SERVICES ASSOCIATION, ) Plaintiff and Appellant, S119869 v. Ct.App. All insurance shall be in a form and with a company satisfactory to Seller and insurance carrier is licensed to do business in the state where the.