Can this statement be e-signed?

Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in 49 states plus DC), electronic signatures are legally valid where the recipient accepts them. Confirm recipient-specific notarization or witness needs before relying on e-signing.

Is notarization required?

Not always. Notarization depends on the recipient or state rules; some lenders and insurers require notarized officer attestations. Check the recipient’s instructions and state notary requirements.

What authentication level is recommended?

Use email + SMS or KBA for higher assurance. For documents needing strong non-repudiation or regulatory-grade records, consider platforms supporting advanced signer authentication and retained audit trails.

How long should I retain the signed statement?

Retain for the agreement term plus at least three years; follow IRS (IRC §6501(a)), HIPAA (45 CFR §164.530(j)), and industry-specific retention rules as applicable.

What if a recipient rejects the statement?

Ask for specific reasons (scope, signer authority, notarization) and address deficiencies promptly; provide supplemental evidence or re-execute with required attestations.

How to update or correct a signed statement?

If the error is clerical, consider executing an amended statement referencing the original date. For material changes, reissue a corrected statement signed by an authorized officer and include an explanation of the amendment.

Electronic Signature
Templates
Miscellaneous
Business Statement of No Losses

Business Statement of No Losses

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BUSINESS STATEMENT OF NO LOSSES

Parties and Effective Date

Business Name:

Business Entity Type

Corporation LLC Partnership Sole Proprietorship Other:

Business Address Business Identification Number

Recipient / Requesting Party:

Effective Date:

Recitals

WHEREAS, the Business is engaged in the operation of its commercial enterprise and is requested by the Recipient to provide a written certification regarding losses, claims, liabilities, and settlements for purposes of evaluation, financing, purchase, or regulatory compliance; and

WHEREAS, the Recipient requires a formal statement that, to the best knowledge and belief of the Business and subject to the disclosures herein, the Business has not sustained or incurred certain specified losses during the period identified below; and

WHEREAS, the Business agrees to provide the statement and related representations set forth in this Statement of No Losses, and the parties intend for this Statement to be relied upon by the Recipient and its affiliates, agents, and advisors.

Scope of Work

Scope — Describe the factual scope and purpose for which this Statement is delivered

Statement of No Losses — Certification

The Business hereby certifies, represents, and warrants that, except as expressly disclosed in the Known Claims and Exceptions section below, between and (the "Coverage Period"), the Business has not sustained, incurred, nor has any pending knowledge of:

Any material loss of business assets, inventory, or equipment exceeding the materiality threshold set by the parties;
Any judgment, settlement, claim, demand, liability, or cause of action against the Business that is material in nature;
Any environmental, health, or safety loss, violation, or remediation obligation that would reasonably be expected to have a material adverse effect on the Business;
Any occurrence of fraud, embezzlement, or material theft by officers, directors, or employees of the Business that would materially impair operations.

Known Claims and Exceptions (if any)

Representations, Remedies, and Indemnity

The Business represents that the statements and disclosures contained herein are true, complete, and correct in all material respects as of the Effective Date. The Business acknowledges that the Recipient may rely upon this Statement in connection with its decisions. If any representation made in this Statement is inaccurate or if a material loss has occurred but was not disclosed, the Business shall indemnify, defend, and hold harmless the Recipient from and against all losses, liabilities, claims, costs, damages, and expenses (including reasonable attorneys' fees) arising from such inaccuracy or omission.

The obligations in this indemnity provision shall survive the termination or expiration of this Statement for a period of two (2) years from the Effective Date, except to the extent a longer survival period is required by applicable law.

Payment Terms (Consideration)

Consideration Amount:

Payment Schedule / Manner of Payment

Late Payment Fee: Interest on overdue balances shall accrue at the rate set forth above, or the maximum lawful rate if lower.

Term and Termination

Term Commencement:

Term Expiration:

Notice Period for Termination

Either party may terminate this Statement for material breach by the other party if such breach is not cured within the notice period set forth above. Termination shall not relieve the Business of liability for breaches or misrepresentations occurring prior to termination.

Confidentiality

All non-public information exchanged between the parties in connection with this Statement, including underlying documentation and disclosures, shall be treated as confidential and used only for the purposes set forth in the Scope of Work. The Recipient agrees not to disclose such information to third parties except to its advisors on a need-to-know basis under customary confidentiality protections or as required by law.

The Business acknowledges and agrees to the confidentiality provisions set forth in this paragraph.

Governing Law; Entire Agreement

Governing Law: This Statement shall be governed by and construed in accordance with the laws of the state governing_choice without regard to its conflict of laws principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in the governing_choice jurisdiction for any disputes arising out of or relating to this Statement.

Entire Agreement: This Statement, including all exhibits and disclosures expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written.

Additional Provisions

Remedies: The remedies provided in this Statement are cumulative and in addition to any other remedies available at law or in equity. The prevailing party in any dispute arising out of this Statement shall be entitled to recover reasonable attorneys' fees and costs.

Additional Notes or Qualifications

Acknowledgment and Certification

The undersigned, being a duly authorized officer or representative of the Business, certifies under penalty of perjury that the information contained in this Statement is true, accurate, and complete to the best of their knowledge and belief, and that they are authorized to execute this Statement on behalf of the Business.

Business — Printed Name:

By (Signature):

Date:

Recipient — Printed Name:

By (Signature):

Date:

What a Business Statement of No Losses Is and when it’s used

A Business Statement of No Losses is a signed declaration by an authorized company representative attesting that the business experienced no financial losses, incidents, or claims over a stated period or in relation to a specified transaction. Commonly used in contractual due diligence, insurance renewals, loan underwriting, and compliance reporting, the statement documents the absence of loss events and supports counterparties who require a formal record. It is often delivered as an affidavit or corporate statement on company letterhead and may require notarization, witness signatures, or an e-signed audit trail depending on the recipient’s requirements and applicable state law.

Why this statement matters to counterparties and regulators

A clear, signed Business Statement of No Losses reduces ambiguity for lenders, insurers, and buyers by providing a formal record that can accelerate underwriting, avoid contingency holds, and support contractual representations. When completed correctly it helps preserve legal protections for the recipient and clarifies the company’s position during negotiations or audits.

Who typically prepares and accepts this statement

Several business roles and external stakeholders commonly create, request, or rely on a Statement of No Losses.

Financial officers verifying absence of insured losses for lenders and insurers
Insurance brokers and underwriters confirming loss history for renewals
Corporate counsel or contracting teams supporting contract representations
Acquirers or diligence teams seeking assurance during M&A or asset sales

The precise preparer and recipient vary by use case; confirm signatory authority and any notarization or authentication requirements before execution.

Step-by-step completion checklist

Follow these steps in order to prepare a complete and legally robust Statement of No Losses.

01

Confirm need: Verify why the statement is requested and whether notarization or witness is required
02

Gather records: Assemble supporting documents covering the statement period (insurance, incident logs)
03

Draft scope: State the scope and period of the no-loss declaration precisely
04

Authorize and sign: Have an authorized officer sign, date, and attach required attestations or notary block

Essential elements to include in a professional statement

A well-structured Statement of No Losses is concise but precise; include all elements below so recipients can verify the claim without follow-up.

Heading

Title the document clearly (Business Statement of No Losses) and reference related agreements or policies the statement supports.

Scope

Define whether the statement covers all loss types or specific categories (property, casualty, cyber, product liability).

Timeframe

Provide exact start and end dates for the reporting period to avoid ambiguity.

Declarant identity

List the legal entity, business address, and EIN to match the company to external records.

Signature block

Include signer name, title, date, and a space for notarization or witness signatures if required.

Supporting note

Optional: reference attached logs, insurance certificates, or incident reports used to verify the no-loss assertion.

How to configure a digital workflow for this statement

Set up an online signing flow to collect signatures, authentication, and an audit trail that meets recipient and regulatory needs.

Field	Configuration
Signature field	Required; set signer role to Authorized Officer
Date field	Auto-fill with sign date on completion
Attachment	Optional file field for supporting evidence
Authentication	Email plus SMS or KBA if recipient mandates higher assurance

Where to send the completed statement and common routing patterns

Decide recipients and routing before signing to ensure the form reaches the correct party and is accepted without rework.

Internal records: Retain a signed copy in corporate compliance files
Insurance carrier: Send to underwriting or loss-control contact for renewals
Lender or investor: Deliver to the assigned loan officer or diligence mailbox
Counterparty legal: Include with transaction closing documents when required

Digital signing and eSubmission considerations

Choose a signing platform that provides strong authentication, a complete audit trail, and retention capabilities that satisfy the recipient.

Authentication: Email, SMS, or knowledge-based authentication (KBA) depending on assurance needs
Audit trail: Capture IP, timestamp, and action log for legal validity
File formats: Use PDF or DOCX to preserve layout and enable long-term retention

Ensure the platform supports ESIGN and UETA compliance, preserves a tamper-evident record, and can export the signed file with its certificate of completion for audits.

Timing expectations and common deadlines

Understand deadlines imposed by counterparties and internal controls so the statement is delivered when required by contract, policy, or renewal cycle.

Insurance renewal:

Often required 30–60 days before policy renewal to avoid underwriting delays

Loan closings:

Requested during due diligence; provide with closing package when required

Contract signing:

Provide before executing representations and warranties in a transaction

Internal audit:

Align submission with fiscal quarter or audit timetable

Regulatory reporting:

Meet any filing windows specified by regulators or grant agreements

Key milestones from draft to recorded statement

A short milestone sequence helps teams coordinate review, approval, signing, and submission.

01

Draft prepared

Legal or finance drafts the statement and defines scope

02

Internal review

Compliance and leadership verify supporting records and accuracy

03

Signatures collected

Authorized officer signs; notarization or witness added if required

04

Distribution and retention

Signed copies delivered to recipients and stored in records system

Quick vendor pricing and capability snapshot for e-signatures

Compare baseline costs and common features across vendors; signNow is listed first per vendor-comparison convention.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Real-world context from user experiences

These condensed examples illustrate how organizations use e-signing and formal statements in practice.

Optica Ventures (COO)

The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers.

Process alignment reduced document turnaround time.
That usability made it straightforward to collect officer attestations and deliver signed statements to lenders and insurers without manual mailing or rekeying.

Martin Properties (Founder)

I can process and execute all of these documents online with 100% compliance and built-in security.

Mobile and offline signing helped field staff capture signatures on site.
This flexibility allowed property managers to submit no-loss attestations quickly during lease renewals and insurance renewals.

Who is legally authorized to sign the statement

CEO / President

The chief executive officer or president typically has corporate authority to make representations about company history and losses; ensure board resolutions or corporate bylaws authorize the individual to sign binding statements on behalf of the entity.

CFO / Controller

The chief financial officer or controller may sign financial attestations related to loss history; when signing, the CFO should rely on internal financial records and auditors to support the no-loss claim.

Common preparation mistakes to avoid

Using an ambiguous timeframe that leaves open which incidents to include
Mismatched legal entity name or missing EIN preventing verification
Omitting required notarization or witness when recipient requires it
Failing to gather supporting records before signing, increasing legal risk

Legal and financial risks of an incorrect or false statement

Civil liability: Counterparties may seek damages if they relied on a false statement to their detriment

Contract rescission: A materially false representation can allow rescission of agreements or claim for indemnity

Tax consequences: Incorrect declarations tied to tax reporting can trigger backup withholding or other tax penalties, including IRC §6721 liabilities

Perjury and fraud: Knowingly false sworn statements may expose signers to criminal penalties under perjury statutes

Insurance impact: False no-loss statements can void coverage or lead to denial of claims

Reputational harm: Material inaccuracies can damage trust with lenders, insurers, and business partners

Practical tips for accurate and efficient completion

Adopt these practices to reduce errors and speed acceptance of the statement.

Use a template

Standardize wording to ensure consistent scope, reduce review cycles, and make future audits straightforward.

Pre-verify signer authority

Confirm corporate authorization (board resolution or bylaw reference) before soliciting signatures to prevent disputes about capacity.

Attach supporting records

Include a list of referenced documents or attach copies (insurance declarations, incident logs) to substantiate the no-loss claim.

Preserve audit logs

When using e-signatures, retain the certificate of completion, audit trail, and exported signed PDF for the retention period.

FAQs and common troubleshooting for the Business Statement of No Losses

Answers to frequent questions about execution, authentication, and post-signature handling of this statement.

Need help? Contact support

Can this statement be e-signed?
Yes. Under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA (adopted in 49 states plus DC), electronic signatures are legally valid where the recipient accepts them. Confirm recipient-specific notarization or witness needs before relying on e-signing.
Is notarization required?
Not always. Notarization depends on the recipient or state rules; some lenders and insurers require notarized officer attestations. Check the recipient’s instructions and state notary requirements.
What authentication level is recommended?
Use email + SMS or KBA for higher assurance. For documents needing strong non-repudiation or regulatory-grade records, consider platforms supporting advanced signer authentication and retained audit trails.
How long should I retain the signed statement?
Retain for the agreement term plus at least three years; follow IRS (IRC §6501(a)), HIPAA (45 CFR §164.530(j)), and industry-specific retention rules as applicable.
What if a recipient rejects the statement?
Ask for specific reasons (scope, signer authority, notarization) and address deficiencies promptly; provide supplemental evidence or re-execute with required attestations.
How to update or correct a signed statement?
If the error is clerical, consider executing an amended statement referencing the original date. For material changes, reissue a corrected statement signed by an authorized officer and include an explanation of the amendment.

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