ACORD Forms
ACORD 37: Statement of No Loss
The ACORD 37 is a statement of no loss. The insured signs it to certify that no losses, claims, or circumstances that could lead to a claim occurred during a stated period, almost always the gap between a cancellation and a requested reinstatement.
What it is
The ACORD 37 is a statement of no loss. The insured signs it to certify that no losses, claims, or circumstances that could lead to a claim occurred during a stated period, almost always the gap between a cancellation and a requested reinstatement.
It is a warranty, not paperwork. The carrier relies on it to reinstate coverage without picking up a loss that already happened, and the signed form documents that the client made the certification, not the agency.
When it's used
- Reinstating a policy cancelled for nonpayment, the most common case.
- Binding or rewriting coverage with an effective date earlier than today.
- After a binding moratorium lifts, when a carrier wants certification that no losses occurred during the hold.
Section-by-section walkthrough
Agency information
Your agency's name and contact details.
Company
The carrier being asked to reinstate or bind the coverage.
Insured and policy information
The named insured, policy number, and the line of business the statement applies to.
Watch for: The wrong policy number on accounts with multiple policies. The statement has to point at the policy being reinstated.
Statement period
The exact dates the no-loss certification covers, typically the cancellation date through the date coverage resumes.
Watch for: Dates that leave part of the lapse uncovered. The period has to bridge the whole gap or the carrier is still exposed and will kick it back.
The no-loss statement
The certification itself: that no losses, accidents, or circumstances likely to produce a claim happened during the period.
Watch for: Completing it without actually asking the client the question. The point of the form is the client's answer.
Signature and date
The insured signs and dates the statement. Only the insured.
Watch for: An agent signing on the client's behalf. Never do this. It converts the client's warranty into the agency's, and it is license and E&O exposure.
In Relay
ACORD Generation is live in Relay. It drafts the ACORD 37 from the client record and the documents you already have, and a person reviews every field before anything goes out. See how →
Common errors
- Agent signs the statement for the client.
- Statement period does not cover the entire lapse.
- Submitted without the premium payment the carrier requires alongside reinstatement.
- Telling the client coverage is back the moment the form is signed. Reinstatement is the carrier's underwriting decision, not automatic.
- A loss did occur during the lapse and the form gets signed anyway. That is misrepresentation, and it unwinds badly.
Common questions
Does a signed ACORD 37 guarantee reinstatement?
No. It lets the carrier consider reinstatement. The carrier can still decline, reinstate with a gap in coverage, or require payment and other conditions first.
What if the client did have a loss during the lapse?
Do not sign the form. The loss almost certainly is not covered, and certifying no loss when one occurred is misrepresentation. Report the situation to the carrier honestly and let underwriting decide how to proceed.
Does payment need to accompany the statement?
Typically yes. Carriers generally want the outstanding premium with the reinstatement request. Send them together, or the request stalls while the lapse keeps growing.
Part of the Relay ACORD form library. Updated 2026-07-11. See how we source content.
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