ACORD 37: Statement of No Loss
ACORD 37 is the Statement of No Loss. It records the insured's statement about the period and circumstances described on the form, often as part of a reinstatement request.
What it is
ACORD 37 is the Statement of No Loss. It records the insured's statement about the period and circumstances described on the form, often as part of a reinstatement request.
The client must supply the factual answer. Do not infer a no-loss statement from an empty claims list or an old application. The carrier decides how to handle the request and any disclosed facts.
When it's used
- A carrier requests a no-loss statement when considering reinstatement.
- The exact period to be addressed has been confirmed with the carrier.
- The insured is available to review the statement and provide the required signature.
Section-by-section walkthrough
Agency information
Your agency's name and contact details.
Review check: Use current agency details.
Company
The carrier being asked to reinstate or bind the coverage.
Review check: Identify the carrier handling the request.
Insured and policy information
The named insured, policy number, and the line of business the statement applies to.
Review check: Match the relevant insured and policy.
Statement period
The exact period the carrier asks the insured to address.
Review check: Use the exact period requested.
The no-loss statement
The insured's factual response to the statement as written on the accepted form.
Review check: Ask the client about the statement's full wording.
Signature and date
The required authorized signature and date for the insured's statement.
Review check: Obtain the required authorized signature and date.
In Relay
Relay can prepare supported ACORD drafts from the documents you provide. This reference guide explains ACORD 37; it is not a promise that this form or edition is available in your workspace. Check the supported form, then review the fields and missing answers before use. See how →
Common errors
- Using dates that do not match the carrier's request.
- Assuming silence in the file means there was no loss.
- Treating a signed statement as proof of reinstatement.
Common questions
Does a signed ACORD 37 guarantee reinstatement?
No. Obtain the carrier's decision and confirmation of the effective date, payment requirements, and any remaining conditions.
What if the client reports a loss or uncertainty?
Do not record a no-loss answer that conflicts with the facts. Give the carrier the accurate information and ask how it wants the request handled. Coverage requires review of the actual policy and circumstances.
Who supplies and signs the statement?
The insured supplies the factual statement. Follow the form and carrier requirements for the authorized signer; the agency should not invent or substitute its own factual certification.
Form references
- ACORD Forms Portal: current forms and authorized access
- ACORD-authored Forms Index, May 2024 (historical form names)
Confirm the form edition and requirements with the market receiving the submission.
Part of the Relay ACORD form library. Updated 2026-07-11. See how we source content.
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