The De Ins Illinois form is a critical document required for individuals seeking licensure under the Illinois Compiled Statutes. This form facilitates the submission of essential information regarding the applicant's insurance coverage, ensuring compliance with state regulations. Proper completion of this form is necessary for processing applications for both new licenses and renewals.
The De Ins Illinois form is a crucial document for individuals seeking licensure under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act in Illinois. This form serves as a supporting document that must be completed and submitted alongside the application for licensure or renewal. It requires personal information from the applicant, including their name, date of birth, and Social Security number, ensuring that the information aligns with the application details. Additionally, the form mandates that the applicant provide proof of comprehensive commercial general liability insurance, which must be in the name of the individual license holder. The insurance policy must meet specific coverage requirements, including a minimum of $1,000,000 in liability insurance for bodily injury, property damage, and personal injury. If the licensee carries a firearm during their duties, the insurance must also cover any claims arising from its use. Furthermore, the insurance agent must complete a section of the form, confirming that the policy meets the necessary requirements and providing their contact information. It is important to note that while disclosing this information is voluntary, failure to complete the form accurately may result in processing delays or denial of the application.
What is the De Ins Illinois form used for?
The De Ins Illinois form is a supporting document required for individuals applying for or renewing their licensure under the Illinois Compiled Statutes. It ensures that applicants have the necessary liability insurance coverage in place, which is vital for protecting both the licensee and the public.
Who needs to complete the De Ins Illinois form?
Both new applicants and those renewing their licenses must complete this form. New applicants will need to provide their personal information and insurance details, while renewal applicants must verify their current insurance coverage.
What information is required from the applicant on the form?
Applicants must provide their name, date of birth, social security number, address, and contact information. Additionally, they need to indicate their profession and the corresponding profession code. New applicants must also include their maiden name or given surname.
What type of insurance is required?
A comprehensive commercial general liability insurance policy is required, with a minimum coverage of $1,000,000. This policy must cover bodily injury, property damage, and personal injury. If the licensee carries a firearm while on duty, the coverage must also extend to claims arising from firearm use.
Can the De Ins Illinois form be submitted without insurance information?
No, the form cannot be processed without the necessary insurance information. Failure to provide this information may result in delays or rejection of the application for licensure or renewal.
What happens if my insurance policy is canceled before its expiration date?
If your insurance policy is terminated prior to its expiration, the insurance company must notify the Department of Financial and Professional Regulation at least 30 days before the cancellation. This requirement ensures that the licensing authority is aware of any changes in your insurance status.
Who should I contact if I have questions about completing the form?
If you have questions about completing the De Ins Illinois form, it is best to reach out to your authorized insurance agent. They can provide guidance on the insurance requirements and help ensure that the form is filled out correctly.
Where do I submit the completed De Ins Illinois form?
The completed form must be submitted along with your application for licensure or renewal. Make sure to double-check that all sections are filled out accurately before submission to avoid any processing issues.
Incorrect Name Entry: One common mistake is entering the name of the insured incorrectly. The name must match exactly as it appears on the application or renewal form. A simple typo can lead to processing delays or rejections.
Omitting Required Information: Applicants often forget to fill in crucial details, such as the social security number or date of birth. Each piece of information is vital for the processing of the application, and missing data can halt the entire process.
Failure to Include Insurance Details: Some applicants neglect to provide complete insurance information, including the policy number and effective dates. This information is essential for verifying coverage and ensuring compliance with state requirements.
Not Submitting with Application: It is important to remember that the completed De Ins Illinois form must accompany the application for licensure or renewal. Submitting the form separately can lead to confusion and delays in the licensure process.
IMPORTANT NOTICE: Completion of this form is
SUPPORTING DOCUMENT
necessary for consideration for licensure under 225 ILCS
DE-INS
446/1 et. seg. (Illinois Compiled Statutes). Disclosure of
CERTIFICATE OF INSURANCE
this information is VOLUNTARY. However, failure to
comply may result in this form not being processed.
APPLICANT: Complete the applicant section of this form, then have your authorized insurance agent complete the remainder of the form. The completed form must be submitted WITH your application for licensure or renewal form. Insurance must be in the name of the individual license holder. The comprehensive, commercial general liability insurance must be in the name of the individual licensee.
1.
NAME OF INSURED (must be exactly as it appears on application,
2.
DATE OF BIRTH
3. SOCIAL SECURITY NUMBER
renewal form of individual license.)
__ __ / __ __ / __ __ __ __
__ __ __ - __ __ - __ __ __ __
Month Day
Year
4.
ADDRESS STREET, CITY, STATE, ZIP CODE (specific address
5.
NEW APPLICANTS ONLY
as noted on license)
REFER TO REFERENCE SHEET. Record profession name and three digit
profession code for which you are making Illinois application.
Profession Name
Profession Code
6.
MAIDEN OR GIVEN SURNAME
7. RENEWAL APPLICANTS AND PERSONS VERIFYING CURRENT
INSURANCE
ONLY -- Record each individual license number you hold
under the Private Detective, Private Alarm, Private Security, Fingerprint
Vendor, and Locksmith Act.
115 -
8.
TELEPHONE NUMBER (where you can be reached during the day-
time)
119 -
Area Code ( ___ ___ ___ ) ___ ___ ___ _ ___ ___ ___ ___
124 -
191 -
Under penalties of perjury, I declare that I have examined the policy and this completed form and to the best of my knowl- edge, the statement is true, correct, and complete.
Signature of Applicant/LicenseeDate
INSURANCE COMPANY/INSURANCE PRODUCER: Complete the following information and return the form to the applicant licensed under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act.
A. NAME OF INSURANCE COMPANY
B. NAME OF AUTHORIZED AGENCY/PRODUCER
C. INSURANCE COMPANY HOME ADDRESS:
D. NAME AND ADDRESS OF AGENT'S BUSINESS: STREET, CITY,
STREET, CITY, STATE, ZIP CODE
STATE, ZIP CODE
E. INSURED'S POLICY NUMBER
F. TITLE OR TYPE OF POLICY
G. AGENT'S BUSINESS TELEPHONE NUMBER
H. EFFECTIVE DATE OF POLICY
I. EXPIRATION DATE OF POLICY
The comprehensive commercial general liability insurance policy, with proof of a minimum of $1,000,000 of liability insurance, must include coverage for bodily injury liability, property damage and personal injury. If the licensee carries a firearm in the course of duty, coverage must extend to claims for injury or damage resulting from the use of firearms while acting in the course of employ- ment. Additionally, if the licensee serves as the licensee in charge of an agency, and the licensee in charge of that agency permits anyone associated with it to carry a firearm, then coverage must extend to claims for injury or damage resulting from the employee's use of firearms while acting in the course of employment. Under penalties of perjury, I declare that I am an autho- rized agent of the above insurance company; I have examined the policy referenced above and this application, and to the best of my knowledge, the policy meets the requirements and provides liability coverage for the licensee's operations in the State of Illinois and statements made here are true, correct and complete. If this policy is terminated prior to expiration, the insurer agrees to provide written notice to the Department of Financial and Professional Regulation thirty (30) days prior to cancellation.
Signature of Agent
Date
IL486-1280 1/13 (DE)
When filling out the De Ins Illinois form, it is essential to follow specific guidelines to ensure your application is processed smoothly. Below are nine important dos and don’ts to consider.
By adhering to these guidelines, you can help ensure that your application is processed efficiently and without unnecessary complications.
The De Ins Illinois form is a crucial document for individuals seeking licensure in specific professions in Illinois. Along with this form, several other documents are commonly required to ensure compliance with state regulations. Below is a list of these documents, each serving a specific purpose in the application process.
Each of these documents plays a vital role in the licensure process in Illinois. Proper completion and submission of all required forms will facilitate a smoother review and approval process for applicants.
This form is a necessary supporting document for anyone seeking licensure under Illinois law. Without it, your application may not be processed, which can delay or prevent your ability to obtain a license.
Both new applicants and those renewing their licenses must fill out this form. Renewal applicants must provide updated information about their insurance coverage, ensuring compliance with state requirements.
It is crucial that the insurance policy is in the name of the individual license holder. This ensures that the coverage is directly applicable to the person seeking licensure, rather than a separate entity.
The form specifies a minimum of $1,000,000 in liability insurance. This amount is not negotiable, as it is set by state regulations to protect both the licensee and the public.
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