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Collects producer contact details, old and new policy numbers, insured information, and the approved underwriter. Includes a certification section stating there have been no losses, accidents, or circumstances that could lead to a claim under the policy referenced above. Provides fields for dates, coverage period, applicant signature and company name, receipt and notary public acknowledgment with seal and commission expiry.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/statement-of-no-loss-declaration-form/277498/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/statement-of-no-loss-declaration-form/277498.png","ImageObject",442,249,{"name":88,"@type":89},"Asher","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-20","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information does the Statement of No Loss collect from the producer?","Question",{"text":109,"@type":110},"It records the producer’s name, address, and phone number, along with approval by the underwriter.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What does the certification section require the applicant to confirm?",{"text":114,"@type":110},"The applicant certifies that there have been no losses, accidents, or circumstances that might give rise to a claim under the policy shown above.",{"name":116,"@type":107,"acceptedAnswer":117},"What acknowledgment and signature steps are included?",{"text":118,"@type":110},"The form includes the applicant’s signature and company name, a receipt received-by section, and a notary public area with seal and commission expiry.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},277498,1790214438,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},687197207639,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","# STATEMENT OF NO LOSS\n\nPRODUCER'S NAME,ADDRESS &PHONE NUMBER:  \n\n| OLD POLICY NUMBER:  \u003Cbr>NEW POLICY NUMBER:   |  |  |\n| --- | --- | --- |\n\nInclude Area Code(  )              \nINSURED'S NAME,ADDRESS &PHONE NUMBER:  \nINSURANCE COMPANY'S NAME:  \nAPPROVED BY(Underwriter):  \n\n| I CERTIFY THAT THERE HAVE BEEN NO LOSSES,ACCIDENTS OR  \u003Cbr>CIRCUMSTANCES THAT MIGHT GIVE RISE TOA CLAIM UNDER  \u003Cbr>THE INSURANCE POLICY WHOSE NUMBER IS SHOWN ABOVE,  \u003Cbr>Date Polc Reistatea  \u003Cbr>anceluation Date  \u003Cbr>_TO_  \u003Cbr>FROM 12:01AM ON  \u003Cbr>Applicant's Signature  \u003Cbr>Name of Applicant's Company  \u003Cbr>RECEIPT  \u003Cbr>RECEIVED BY:_  \u003Cbr>Producer  \u003Cbr>Date  \u003Cbr>Notary Public  \u003Cbr>Affix Notary  \u003Cbr>Seal Here  \u003Cbr>My Commission Expires   |\n| --- |","cbCaioNwo5VIehXZ","https://ap.wps.com/l/cbCaioNwo5VIehXZ","pdf",38117,"English","# STATEMENT OF NO LOSS\n## Producer information\n## Policy and insured details\n## Certification of no loss\n## Signatures, receipt, and notary acknowledgment","[{\"question\":\"What information does the Statement of No Loss collect from the producer?\",\"answer\":\"It records the producer’s name, address, and phone number, along with approval by the underwriter.\"},{\"question\":\"What does the certification section require the applicant to confirm?\",\"answer\":\"The applicant certifies that there have been no losses, accidents, or circumstances that might give rise to a claim under the policy shown above.\"},{\"question\":\"What acknowledgment and signature steps are included?\",\"answer\":\"The form includes the applicant’s signature and company name, a receipt received-by section, and a notary public area with seal and commission expiry.\"}]","STATEMENT OF NO LOSS - declaration form | PDF",1789501524]