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statement of no loss 21515 hawthorne blvd suite 440 torrance, ca 90503 agency code: sub code: approved by 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 . cancellation date date and time signed applicant's.
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Title: Customer Service Home Page Author: ben.lynds Created Date: 4/14/2011 8:00:17 AM
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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 . acord statement of no loss. author: suzanne cowan created date: 8/15/2012 4:19:52 pm title.
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11+ Statement Of No Loss Acord 37 FerneMischa
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 corporation 1996 cancellation date date and time signed applicant's signature producer witness date and.
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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 _____. I 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
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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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Created Date: 11/11/2015 10:24:53 AM
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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 circumstances that might give rise to a claim under the insurance policy whose number is shown above, from 12:01 am on to . cancellation date date and time signed policy #
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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. Title: ACORD 37 - No Loss Letter Author: mroy Created Date:
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ACORD 37 Statement of No Loss. Use the clickable sections in the form below to find corresponding fields in Sagitta. When you have a question about a field on the form, click its section to access the list of Sagitta fields that populate that section of the form. ACORD 37 2008/01 Statement of No Loss ©
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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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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:
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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)