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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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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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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.
ACORD.37/87 CSJN (Del 24/XI/1987) REGISTRO Y
Title: ACORD 37 (2008/01) Author: ACORD Corporation Created Date: 8/24/2011 2:01:49 PM
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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 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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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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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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acord 37 (1/96) oc acord corporation 1996 cancellation date date and time signed applicant's signature producer witness date and timedate and time acord tm. title: alarm installers program author: penn-america group subject: applications created date: wednesday, march 03, 1999 9:22:43 am.
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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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Created Date: 11/11/2015 10:24:53 AM
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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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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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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.