Statement Of No Loss Pdf

File name: Statement Of No Loss Pdf

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% Money Back Guarantee · Over k Legal Forms · 3M+ Satisfied Customers. certify that there have been no losses or accidents that might give rise to a claim under my automobile insurance policy listed above from the cancellation/expiration date of . I further certify and affirm that there have been no losses, incidents, or circumstances that might give rise to a claim under the policy for which I am applying. I understand that any . I CERTIFY THAT I AM NOT AWARE OF ANY LOSSESS, ACCIDENTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO A CLAIM UNDER THE INSURANCE POLICY WHOSE NUMBER IS SHOWN BELOW FROM AM ON _____________________ TO __________________________. CANCELLATION DATE DATE AND TIME SIGNED. certify that there have been no losses or accidents that might give rise to a claim under my automobile insurance policy listed above from the cancellation/expiration date of __________________ at am until ____________________________(date and time). The purpose of this no loss letter is to assist in the underwriting process; information contained herein is specifically relied upon in determination of insurability. The undersigned, therefore, warrants that the information contained herein is true and accurate to the best of his/her knowledge, information and belief. certify that there have been no losses or accidents that might give rise to a claim under my automobile insurance policy listed above from the cancellation/expiration date of __________________ at am until ____________________________(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 am on to. acord 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 policy number named insured approved by the acord name and logo are registered marks of acord.