the acord name and logo are registered marks of acord approved by named insured policy number carrier naic code fax (a/c, no): agency name: contact (a/c, no, ext): phone code: subcode: agency customer id: address: e-mail statement of no loss cancellation date date and time signed from 12:01 am on to . the insurance policy whose number is shown ...

statement of no loss producer insured’s name telephone number: company: approved by: code: sub code: policy # 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 . receipt $ amount received by: acord 37 (1/96) oc acord ...

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,

The ACORD name and logo are registered marks of ACORD RECEIPT 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 . STATEMENT OF NO LOSS. Title: Statement Of No Loss (2008/01)

STATEMENT OF NO LOSSES (READ CAREFULLY BEFORE SIGNING) As condition precedent to the reinstatement of my policy, I, the undersigned, state that no loss has occurred for which coverage might be claimed under my POLICY NUMBER _____between the date of _____12:01 a.m. (local time) and _____.

The ACORD Statement of No Loss is a crucial form for confirming there have been no claims under an insurance policy. This form is essential for accurate record-keeping and preventing future discrepancies in insurance claims.

2 days ago · ACORD Forms Index Please provide the information below to avoid delay in shipment. ... Selection, Rejection Form 5 712019/09 Aircraft Loss Notice 6 722009/05 Aviation Witness / Passenger Schedule 7 Solid Fuel Questionnaire 2009/05 Aviation Injured Schedule 11 2/95 Auto Accident Information Form ...

STATEMENT OF NO LOSS E-MAIL ADDRESS: AGENCY CUSTOMER ID: CODE: SUBCODE: PHONE (A/C, No, Ext): CONTACT NAME: AGENCY (A/C, No): FAX CARRIER NAIC CODE POLICY NUMBER NAMED INSURED APPROVED BY The ACORD name and logo are registered marks of ACORD. ACORD@ Created Date:

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 .

Instructions to complete the Statement of No Loss are as follows: 1. Authorization to submit a No Loss Statement must be given by Underwriting PRIOR to submission.