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ACORD 37, Statement of No Loss, page 1
Basic · 34/100Form Complexity Index

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What this form asks for

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The ACORD 37, also known as the Statement of No Loss, is a standard insurance industry form used by a policyholder to declare that they have not experienced any losses, accidents, or circumstances that could lead to a claim during a period when their coverage may have lapsed. This certification is typically required by an insurance carrier before reinstating a policy, ensuring no new risks are being assumed from the lapse period. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields30
Pages1
Form Complexity IndexBasic, 34/100

The AI checks your answers before you download

13 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Policy Number Format and Existence

This check verifies that the 'POLICY NUMBER' field is not empty and conforms to the carrier's standard format, which is typically an alphanumeric string. A valid policy number is essential for linking the statement to the correct insurance contract. If the number is missing or malformed, the system cannot process the statement and it will be rejected for manual review.

NAIC Code and Carrier Consistency

This validation ensures the 'NAIC CODE' is a 5-digit number and corresponds to the code registered to the specified 'CARRIER'. This cross-reference is crucial for regulatory compliance and correct routing of information. A mismatch can lead to processing delays and indicates a potential data entry error for either the carrier name or the NAIC code.

Logical Signature Date

This check confirms that the 'DATE AND TIME SIGNED' is on or after the 'CANCELLATION DATE'. The insured cannot logically attest to having no losses during a coverage gap before that gap has concluded. A signature date prior to the cancellation date would invalidate the statement's purpose and will cause the submission to be flagged for correction.

Mandatory Applicant Signature

This validation verifies that the 'APPLICANT'S SIGNATURE' field contains a signature, whether digital or an uploaded image. As a legally binding document, the statement is void without the applicant's signature. Failure to provide a signature will result in an immediate rejection of the form submission.

Cancellation Date Format and Plausibility

This check ensures the 'CANCELLATION DATE' is a valid date in a standard format (e.g., MM/DD/YYYY) and is not a future date. The cancellation date marks the beginning of the coverage lapse, so it must be a real, historical date. An invalid or future date would make the no-loss period nonsensical and will prevent the form from being processed.

Contact Phone Number Structure

This validation checks that the 'PHONE' number field contains a valid 10-digit number, allowing for common formatting characters like parentheses, spaces, and hyphens. A correctly formatted phone number is essential for the agency or carrier to contact the insured if there are questions about the statement. Submissions with invalid numbers may be delayed until contact information is corrected.

And 7 more checks
  • Email Address Syntax Validation
  • Named Insured Completeness
  • Carrier Name Completeness
  • Producer Information Presence
  • No-Loss Period Chronology
  • Receipt Information Integrity
  • Agency Customer ID Format

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How to Fill Out ACORD 37 Online for Free in 2026

What the AI walks you through.

  1. Navigate to Instafill.ai and upload or select the ACORD 37 form.
  2. Use the AI tool to automatically populate agency and carrier information, including names, NAIC codes, and contact details.
  3. Enter the Named Insured's information and the specific Policy Number.
  4. Specify the policy's cancellation date and the time period (from/to) for which you are certifying no loss.
  5. Carefully review the certification statement confirming you are not aware of any losses or accidents.
  6. Apply your digital signature and the date/time to finalize the certification.
  7. Review all entered information for accuracy before downloading or sharing the completed, legally-binding document.

Common Mistakes in Completing ACORD 37

The ones the AI is built to catch.

Entering an Incorrect Policy Number
This often happens due to simple typographical errors, such as transposing digits or omitting characters. Using an incorrect policy number is a critical error because it prevents the insurance carrier from locating the policy record. As a result, the Statement of No Loss cannot be processed, and the request to reinstate coverage will be rejected, causing significant delays.
Omitting the Time of Signature
Applicants frequently fill in the date but forget to include the specific time of signing. This form explicitly requires the time because it establishes the exact moment up to which the insured is attesting there have been no losses. A form without the time may be considered incomplete and rejected by the carrier, as a loss could theoretically occur on the same day before the form was signed.
Using an Incorrect 'Named Insured'
The 'Named Insured' field must match the full legal name or business name exactly as it appears on the insurance policy documents, not a nickname or abbreviation. This mistake occurs when an individual uses a common name or a business owner doesn't use the full legal entity name. A mismatch can cause the carrier's system to fail to identify the policy, leading to rejection of the form.
Misunderstanding the 'No Loss' Certification
Signing this form while being aware of a loss, accident, or any circumstance that could lead to a claim is a serious error. Some individuals may underestimate a minor incident or sign out of a desire to reinstate coverage quickly, not realizing this constitutes insurance fraud. This can lead to claim denial, policy cancellation, and potential legal action.
Confusing the Statement Date Range
The form requires a statement period 'FROM' a specific date 'TO' the current date and time of signing. People often mistakenly enter incorrect dates, especially in the 'FROM' field, which should be the policy's cancellation date. An incorrect date range invalidates the legal attestation, as the carrier needs a clear, unbroken statement covering the entire lapse period.
Illegible Handwriting on a Printed Form
This form is often provided as a non-fillable PDF, forcing users to print and complete it by hand, which can result in illegible handwriting. A misread policy number, name, or date can lead to data entry errors by the carrier, causing processing to fail entirely. To avoid this, print clearly in block letters or use a tool like Instafill.ai, which can convert flat PDFs into fillable forms, allowing you to type for perfect clarity.
Providing an Unauthorized Signature
The form must be signed by the 'Named Insured' or a legally authorized representative (e.g., a corporate officer). A common mistake is having a spouse, employee, or other individual who is not listed as the named insured sign the document. An unauthorized signature makes the statement legally void and will result in immediate rejection by the carrier.
Incomplete Agency or Carrier Information
Applicants sometimes leave the Agency, Carrier, or NAIC Code fields blank, assuming the recipient already knows this information. This can slow down internal routing and processing, especially if the form is submitted to a general mailbox. To prevent delays, all fields should be filled out completely; AI-powered tools like Instafill.ai can help by auto-filling correct and validated information from a user's profile.
Failing to Distinguish Between Agency and Carrier
Policyholders often confuse their local insurance agency (the producer) with the actual insurance company (the carrier) that underwrites the policy. They might incorrectly write the agency's name in the 'CARRIER' field. This mistake can cause the form to be misrouted, significantly delaying the reinstatement process until the error is caught and corrected.

Frequently Asked Questions About ACORD 37

 

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How does the AI fill out ACORD 37?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of ACORD 37, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is ACORD 37 to fill out?
ACORD 37 has a Form Complexity Index of 34 out of 100, in the basic tier: 30 fillable fields across 1 page. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of the Statement of No Loss form?
This form is a legal declaration you make to your insurance carrier, certifying that you have not had any losses or incidents that could lead to a claim during a period when your policy was not active.
Why am I being asked to sign a Statement of No Loss?
You are typically asked to sign this form when you want to reinstate a canceled insurance policy. It assures the insurance company that no claims occurred during the coverage gap, allowing them to reinstate your policy.
Who is the 'Named Insured'?
The 'Named Insured' is the primary person or entity listed on the insurance policy. You should enter your name exactly as it appears on your policy documents.
What information do I need to have ready to fill out this form?
You will need your insurance policy number, the name of your insurance carrier (and its NAIC code if known), and the date your policy was canceled. This information can be found on your old policy documents or by contacting your agent.
What dates should I enter in the 'FROM' and 'TO' fields?
The 'FROM' date is your policy's cancellation date, and the 'TO' date is the date you are signing the form to reinstate coverage. This represents the period during which you had a lapse in insurance.
What does 'circumstances that might give rise to a claim' mean?
This refers to any event, even if it seems minor, that could potentially lead to you filing an insurance claim in the future. If you are unsure, it is best to discuss the situation with your insurance agent before signing.
What happens if I sign this form but a loss actually occurred during the lapse period?
Signing this form dishonestly can be considered insurance fraud, which is a serious offense. Your reinstated policy could be voided, any related claims denied, and you could face legal consequences.
What should I do if I'm not sure whether an incident needs to be reported?
If you are uncertain about any incident that occurred during the lapse period, you must discuss it with your insurance agent or carrier before signing this form. It is crucial to be completely transparent.
Who fills out the 'PRODUCER' and 'RECEIPT' sections at the bottom?
These sections are for internal use by your insurance agent (the producer) or the insurance company. As the applicant, you only need to complete the top portion and provide your signature, along with the date and time.
How do I submit the completed form?
Your insurance agent or carrier will provide instructions for submission. Typically, you can return the signed form via email, fax, or postal mail.
Can I use an AI tool to help me fill out this form?
Yes, AI-powered services like Instafill.ai can help you accurately auto-fill your personal details and other known information, saving you time and reducing errors. However, the certification about no losses must be based on your personal knowledge.
How can I fill out the Statement of No Loss online using Instafill.ai?
Simply upload the form to the Instafill.ai platform, and its AI will identify the fields. You can then click to fill them with your saved information or type directly into the digital form before printing or submitting it.
The PDF version of this form I received is not fillable. What can I do?
You can use a service like Instafill.ai, which can convert flat, non-fillable PDFs into interactive, fillable forms. This allows you to easily type your information into the correct fields on your computer.
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policy service forms: Transamerica Policy Service Request (Form MPS61008T), ACORD 35, Cancellation Request / Policy Release, ACORD 36, Agent/Broker of Record Change

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