No Loss Accord Form

No Loss Accord Form - Acord 37 2008 01 1996 2008 acord corporation all rights reserved witness date and time receipt amount received by producer applicant s signature i certify

Tm producer insured s name telephone number company approved by code subcode policy cancellation date date and time signed applicant s signature

No Loss Accord Form

No Loss Accord Form

Since our first paper form was released in 1971, ACORD has provided the standard forms used by the insurance industry. ACORD Forms are now available in a variety of formats, including printable PDF, electronic fillable, and eForms. Using ACORD's standardized Forms allows for increased efficiency, accuracy, and speed of information processing.

CANCELLATION DATE DATE AND TIME SIGNED APPLICANT S SIGNATURE RECEIPT AMOUNT RECEIVED BY PRODUCER WITNESS DATE AND TIME I CERTIFY THAT THERE HAVE BEEN NO LOSSES ACCIDENTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO A CLAIM UNDER THE INSURANCE POLICY WHOSE NUMBER IS SHOWN ABOVE FROM 12 01 AM ON TO

Span Class Result Type

RECEIPT AMOUNT RECEIVED BY PRODUCER WITNESS DATE AND TIME I CERTIFY THAT I AM NOT AWARE OF ANY LOSSES ACCIDENTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO A CLAIM UNDER THE INSURANCE POLICY WHOSE NUMBER IS SHOWN ABOVE FROM 12 01 AM ON TO

No Loss No Gain

A no loss statement is a statement signed by you in which you represent and promise that you have not had any loss or claim either liability or property damage between the time your policy canceled and the time you re applying for reinstatement your lapse period Think of it like a signed testimonial that you haven t been in an auto

Span Class Result Type

Created Date 11 11 2015 10 24 53 AM

FREE 10 Sample Acord Forms In PDF MS Word

Understand that Ascendant Commercial Insurance is relying solely upon this statement of no losses as an inducement to reinstate my policy I further understand if a loss has occurred for which coverage might be claimed under the above policy number between the dates indicated the reinstatement is NULL AND VOID and no coverage shall exist under

CANCELLATION DATE DATE AND TIME SIGNED. APPLICANT'S SIGNATURE. RECEIPT. $ AMOUNT RECEIVED BY: PRODUCER. WITNESS DATE AND TIME. I CERTIFY THAT I AM NOT AWARE OF ANY LOSSES, ACCIDENTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO A CLAIM UNDER THE INSURANCE POLICY WHOSE NUMBER IS SHOWN ABOVE, FROM 12:01 AM ON TO .

ACORD Forms

Acord 37 1 96 c acord corporation 1996 witness date and time receipt amount received by producer applicant s signature i certify that there have been no losses accidents or

No Loss Accord Form

Understand that Ascendant Commercial Insurance is relying solely upon this statement of no losses as an inducement to reinstate my policy I further understand if a loss has occurred for which coverage might be claimed under the above policy number between the dates indicated the reinstatement is NULL AND VOID and no coverage shall exist under

Tm producer insured s name telephone number company approved by code subcode policy cancellation date date and time signed applicant s signature

No Loss Letter 2009 2023 Form Fill Out And Sign Printable PDF Template SignNow