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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.
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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
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ACORD 37 2008/01 Statement of No Loss 01 Fill and edit template 02 Sign it online 03 Export or print immediately A Statement of No Loss Form is a simple one-page letter that ensures that you haven't faced any losses that can result in claims. This signed document is used in the insurance field, and you need to provide it to your insurer.
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TITLE. ACORD 37 (2008/01) STATEMENT OF NO LOSS. ACORD 37, Statement of No Loss is used when: * A policy issued by your agency has been cancelled, or has lapsed, because premium for. the policy was not paid in time; * The former insured desires to pay the delinquent premium and reinstate insurance. without a lapse in coverage; and.
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description of operations / locations / vehicles (attach acord 101, additional remarks schedule, if more space is required) insr ltr type of insurance policy number policy eff (mm/dd/yyyy) policy exp (mm/dd/yyyy) limits wc statu-tory limits oth-er e.l. each accident e.l. disease - ea employee e.l. disease - policy limit $ $ $ any proprietor.
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ACORD Forms increase your efficiency. 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.
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Acord 37 statement of no loss data-mc-breadcrumbs-number =3 data-mc-toc=True>> Teforms > Use the tabs that can be clicked in the form below to find the corresponding fields in Saghita. When you have a question about a field on the form, click its tab to open the list of THE fields that fill in this section of the form.
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Acord 37: No Loss Statement. Acord 60: Oklahoma Personal Auto Supplement. Acord 61: Arkansas Personal Auto Supplement. Acord 67: Arkansas EQ Coverage Rejection Form.. Acord 138: Oklahoma Garage & Dealers Application. Acord 140: Property Section Application. Acord 141: Crime Section 2000.
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NAMED INSURED. NAMED INSURED. NAMED INSURED. NAMED INSURED. 21515 Hawthorne Blvd Suite 440 Torrance, CA 90503. 21515 Hawthorne Blvd Suite 440 Torrance, CA 90503. 21515 Hawthorne Blvd Suite 440 Torrance, CA 90503. CONTACT NAME:
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tm producer insured's name telephone number: company: approved by: code: subcode: policy # cancellation date date and time signed applicant's signature
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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.
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Section Name Field Name Field and/or Section Description TITLE ACORD 37 (2008/01) Statement of No Loss Use ACORD 37 when: * A policy issued by your agency has been cancelled, or has lapsed, because premium for the policy was not paid in time; * The former insured desires to pay the delinquent premium and reinstate insurance without a lapse in co.
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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.
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Title: ACORD 37 (2008/01) Author: ACORD Corporation Created Date: 8/24/2011 2:01:49 PM
