Can the letter be e-signed?

Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted. Confirm the insurer accepts electronic signatures and follow any required authentication or consumer-disclosure steps.

Is notarization ever required?

Not typically for routine letters, but some insurers or state rules may require notarization or witness signatures for formal affidavits. Check insurer instructions and state notary rules before dispensing with notarization.

What if prior losses exist?

Disclose any known incidents. Failing to disclose material losses can lead to coverage denial or rescission; accurate full disclosure preserves coverage integrity and avoids fraud claims.

How do I correct a submitted letter?

Issue a corrected letter signed by an authorized representative and include an explanation; retain the original and corrected versions in the record for audit purposes.

Who is an authorized signer?

An authorized signer is an individual with delegated authority (owner, officer, risk manager, or authorized broker). Document the signer’s authority in corporate records or broker agreements as needed.

How long should copies be kept?

Retain signed letters per business and regulatory retention rules: at least three years generally, six years for HIPAA-related records, and longer where state law or contract requires.

Electronic Signature
Templates
Insurance
Insurance No Known Losses Letter

Insurance No Known Losses Letter

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

Insurance No Known Losses Letter

Recipient Name: Company:

Date of Letter:

Insured / Applicant Information

Insured Name Insured Address Contact Phone Contact Email

Policy Details

Insurer Name Policy Number

Policy Type: Coverage Limit: $

Deductible: $ Premium: $

Policy Period From: To:

Coverage Types (select all applicable)

General Liability Property Automobile

Workers' Compensation Professional Liability / E&O Other:

Statement of No Known Losses

For the period from through , the undersigned hereby certifies that to the best of the undersigned's knowledge and belief there have been no occurrences, incidents, claims, suits, demands, notices of potential loss, or circumstances likely to give rise to a claim under the policy referenced above.

This statement is made for the purpose of inducing the recipient to rely thereon in evaluating coverage and underwriting risk. The undersigned further represents that there are no facts, circumstances or information within the undersigned's knowledge that would reasonably be expected to give rise to a loss, claim, or suit during the stated period.

If any known or reported matters exist, describe below

Exclusions and Limitations

This letter is a statement of fact only and does not: (a) amend, alter, extend, or waive any policy term, condition, exclusion or limitation; (b) constitute an admission of liability by the insurer or the insured; or (c) create coverage where none exists. The recipient may rely on this statement only for the specific purpose for which it was furnished. Any material misrepresentation or omission may result in denial of coverage, adjustment of coverage, rescission of the policy, or other remedies available under the policy or applicable law.

Beneficiary Information (if applicable)

Beneficiary Name

Relationship: Percentage: %

Declaration

I hereby declare under penalty of civil liability for material misrepresentation that the information provided in this letter is true, correct and complete to the best of my knowledge. I agree to promptly notify the recipient in writing if any information set forth herein changes or if any claim, notice, or circumstance arises that may reasonably give rise to a claim under the referenced policy.

Applicant Name:

By:

Date:

Definition and purpose of the Insurance No Known Losses Letter

An Insurance No Known Losses Letter is a written statement provided by a policyholder, applicant, or insured party declaring that, to their knowledge, no incidents, claims, or potential losses have occurred during a specified period. Insurers commonly request this letter at policy inception, renewal, or when underwriting changes are pending to verify exposures and finalize coverage terms. The letter documents the insured's representations about loss history and supports underwriting decisions, premium calculations, and fraud-prevention checks.

Why this letter matters for underwriting and recordkeeping

A clear No Known Losses Letter reduces underwriting delays, clarifies risk disclosure, and documents the insured's attestation for audit trails and future claim handling.

Who completes or receives this letter

Typical creators and recipients include individuals, businesses, insurers, and brokers involved in policy placement.

Policyholders and applicants who must attest to their loss history when applying or renewing coverage.
Insurance brokers and agents submitting attestation letters to underwriters during placement or quote requests.
Underwriting teams and claims auditors who rely on written attestations for risk assessment and recordkeeping.

Recipients should store the letter with policy files and audit records to support future underwriting or claim inquiries.

Step-by-step: preparing a compliant No Known Losses Letter

Follow these ordered tasks to prepare, verify, and deliver an accurate attestation letter to the insurer.

01

Gather policy data: Collect policy number, effective dates, coverage types.
02

Draft attestation: State explicitly that no known losses exist for the stated period.
03

Sign and date: Have authorized signer sign and add the execution date.
04

Deliver to insurer: Send via insurer-specified channel and retain proof of delivery.

Typical routing and handling of the letter

Understand common handoffs so the letter reaches underwriting and is retained with policy records.

Policyholder prepares: Insured or authorized representative drafts attestation.
Broker review: Broker or agent validates policy identifiers and wording.
Submit to insurer: Send to underwriting or the specified claims contact.
File with policy: Insurer attaches letter to electronic policy file.

Configuring a digital workflow for the letter

Set minimal but verifiable authentication and tracking to preserve legal enforceability and auditability.

Field	Configuration
Signer identity	Email + SMS code or higher
Signature type	Electronic signature with audit trail
Document retention	Secure storage with exportable audit log
Delivery confirmation	Return receipt or signed certificate

Technical considerations for eSigning and storage

Choose tools that preserve an audit trail, support common formats, and meet regulatory controls for sensitive data.

File formats: PDF and DOCX supported
Integration options: Salesforce, NetSuite, Microsoft 365
Authentication: Email, SMS, or advanced methods

Maintain tamper-evident records and secure access controls so signed letters can be reproduced for audits or claims.

Comparing eSignature options relevant to this letter

Pricing and compliance features vary by vendor; signNow appears first and pricing is shown on an annual-billing basis where provided.

	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 (premium plan)	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Essential data to include in the letter

Policyholder Name: Full legal name as on ID

Policy Number: Exact insurer policy identifier

Policy Period: MM/DD/YYYY start and end

Statement Period: Dates covered by the attestation

Attestation Text: Clear no-loss declaration

Signature Details: Name, title, signature date

Consequences of incorrect or misleading attestation

Coverage Denial: Insurer may deny related claims

Policy Rescission: Policy can be voided retroactively

Premium Adjustment: Rates may be recalculated

Fraud Allegations: Possible civil or criminal risk

Contractual Breach: Third-party remedies could apply

Delayed Claims: Investigation and payment delays

Common preparation and submission errors to avoid

Using informal or ambiguous language that fails to explicitly state the attestation period and the absence of known losses.
Entering incorrect policy numbers or mismatched policyholder names that cause underwriting to request re-verification.
Failing to use an authorized signer or to document the signer's title, which can invalidate the attestation for underwriting.
Submitting the letter through an untraceable channel without delivery confirmation, leaving no proof of receipt or timestamp.

Practical tips for accuracy and efficiency

Combine clear wording, accurate identifiers, and verifiable delivery to minimize underwriting follow-ups and protect coverage positions.

Confirm identifiers before sending

Verify the policy number and legal entity name against the insurer's records to prevent administrative delays and potential mismatches during underwriting checks.

Use precise attestation language

State the attestation in plain terms, reference the exact dates covered, and avoid qualifiers such as 'to our knowledge' unless that is the intended legal standard.

Capture signer authority

Include the signer’s printed name, title, and contact information to document authority and facilitate insurer follow-up when verification is needed.

Retain proof of delivery

Keep delivery receipts, signed copies, or an electronic audit trail to support records requests or disputes during underwriting or claims.

Two illustrative examples of use

Sample scenarios show typical content and why precise wording matters when insurers review attested history.

Midterm Renewal Example

A small contractor submits a letter stating no known losses for the prior 12 months

Underwriter notes unchanged exposure and updates the renewal quote quickly
The precise dates, policy number, and authorized signature reduced follow-up and preserved original premium terms.

Lender Insurance Check

A borrower provides a lender-requested no-loss attestation covering a property policy

Escrow requires confirmation of no open claims
Clear property address, mortgagee clause, and signer title satisfied loan closing timetables without additional insurer contact.

Timing considerations and expected response windows

Respond promptly when an insurer requests the letter; common timing points are renewal, new coverage, or underwriting inquiries.

At renewal:

Provide as part of renewal packet before effective renewal date

On insurer request:

Respond according to insurer deadline; often within 30 days

Before new coverage:

Submit prior to policy inception or binding

For audits:

Supply during audit windows specified by underwriter

Upon notice of change:

Update letter whenever material exposure changes occur

Who typically signs and why their role matters

Claims Manager

A Claims Manager signs when authorized to attest about loss history for an organization; signature confirms internal searches were made and supports insurer reliance on the statement.

Insurance Broker

A Broker may prepare and sign attestation on behalf of a client when explicitly authorized; broker signatures should be accompanied by documented client authorization.

Frequently asked questions about the Insurance No Known Losses Letter

Answers to common questions about validity, signing methods, notarization, and correction procedures.

Need help? Contact support

Can the letter be e-signed?
Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted. Confirm the insurer accepts electronic signatures and follow any required authentication or consumer-disclosure steps.
Is notarization ever required?
Not typically for routine letters, but some insurers or state rules may require notarization or witness signatures for formal affidavits. Check insurer instructions and state notary rules before dispensing with notarization.
What if prior losses exist?
Disclose any known incidents. Failing to disclose material losses can lead to coverage denial or rescission; accurate full disclosure preserves coverage integrity and avoids fraud claims.
How do I correct a submitted letter?
Issue a corrected letter signed by an authorized representative and include an explanation; retain the original and corrected versions in the record for audit purposes.
Who is an authorized signer?
An authorized signer is an individual with delegated authority (owner, officer, risk manager, or authorized broker). Document the signer’s authority in corporate records or broker agreements as needed.
How long should copies be kept?
Retain signed letters per business and regulatory retention rules: at least three years generally, six years for HIPAA-related records, and longer where state law or contract requires.

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