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: …
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 …
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STATEMENT OF NO LOSS
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 . …
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,
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 …
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,
I am not aware of any incident, event, occurrence, loss, or accident which might give rise to a demand for compensation, a civil action, suit, or institution of arbitration proceeding.
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 …
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STATEMENT OF NO LOSS
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 …
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 …
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