Statement of No Loss


(4.8 / 5) 67 votes

Get your Statement of No Loss in 3 easy steps

  • 01 Fill and edit template Fill Statement of No Loss
  • 02 Sign it online Sign Statement of No Loss
  • 03 Export or print immediately Export Statement of No Loss

What is a Statement of No Loss? 

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 before they proceed to reinstate or issue your insurance policy.

Statement of No Loss Template Form Screenshot

What do I need the statement of no loss letter for? 

  • You might be required to fill out a Statement of No Loss template in the following cases:

  • If you signed an application for coverage throughout a moratorium period;

  • If your policy ceased its work or was canceled but you want it to be reinstated;

  • To affirm that your household didn’t experience any damage at the time of signing, so it won’t lead to further claims.

How to Fill Out a Statement of No Loss Template? 

  1. To get a Statement of No Losses fillable template, you should press the “Fill this form” button on this very page.

  2. You will see a blank with editable blue fields. By providing the essential data, you will have the chance to print the form and give it to your insurance agent.

  3. Click on the date field and specify the current date.

  4. Provide your and your agent’s names in the appropriate text fields.

  5. Enter the cancellation date and the time you sign this letter.

  6. Write the name of the insured, the policy number, and the carrier name as required in the blue sections below.

  7. Provide a title and add your e-signature by using a smart e-signing feature. 

  8. Press the red “Done” button in the upper right corner of the page to save all the changes you have made in the doc.

  9. This is a printable form version, so you can save this document as a PDF on your device and print it out for further use.

FAQ: Statement of No Loss Letter Popular Questions

  • How do you write a No Loss Letter?

    To write a No Loss Letter, you don’t need to use a pen and a blank page. There’s no need to do it from scratch and browse the Web for vague guidelines. A reliable platform with numerous form templates like PDFLiner can help you complete this letter online.

  • When should I fill out a Statement of No Loss template?

    You have to fill out this blank if you need to reinstate your existing policy. Thus you confirm that your insurance company won’t bear any financial obligations for the previous loss it wasn’t aware of.

  • How to sign a No Loss Statement?

    Though you can do it manually, it’s an old-school method. With PDFLiner, you can use a smart e-signing feature and sign a no-loss statement online before you print it out. Choose the tool on the upper dashboard and pick one of the three options available. You can upload an image of your existing signature, draw a new one with a drawing tool, or type a signature in the appropriate field. It will be transformed into a handwritten form.

Fillable online Statement of No Loss
(4.8 / 5) 67 votes
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