No Loss Statement Acord Form - * a policy issued by your agency has been cancelled, or has lapsed, because premium for the policy was not paid in time; Web indicate the time the form was signed (e.g., 10:00 a.m.) by the witness. Section name field name field and/or section description title acord 37 (2008/01) statement of no loss use acord 37 when: Cancellation date date and time signed policy # * the former insured desires. 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. Web acord 37 (1/96) c acord corporation 1996 witness date and time receipt $ amount received by: Fax carrier naic code policy number named insured approved by the acord name and logo are registered marks of acord.
Web indicate the time the form was signed (e.g., 10:00 a.m.) by the witness. Cancellation date date and time signed policy # Fax carrier naic code policy number named insured approved by the acord name and logo are registered marks of acord. * a policy issued by your agency has been cancelled, or has lapsed, because premium for the policy was not paid in time; Web 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. Section name field name field and/or section description title acord 37 (2008/01) statement of no loss use acord 37 when: * the former insured desires.