The De Ins Illinois form is a crucial document required for individuals seeking licensure under the Illinois Compiled Statutes. This form serves as a supporting document to verify that applicants have the necessary insurance coverage, which is essential for compliance and processing their applications. Completing this form accurately is vital, as any omissions may hinder the licensure process.
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The De Ins Illinois form serves as a critical document for individuals seeking licensure under the Illinois Compiled Statutes, specifically 225 ILCS DE-INS 446/1 et. seq. This form is essential for both new applicants and those renewing their licenses in professions such as private detective, private alarm, private security, fingerprint vendor, and locksmith. The form requires applicants to provide personal information, including their name, date of birth, social security number, and contact details. An authorized insurance agent must complete the insurance section, which details the comprehensive commercial general liability insurance policy held by the applicant. This policy must include a minimum coverage of $1,000,000 and extend to bodily injury, property damage, and personal injury claims. Additionally, if the licensee carries a firearm during their duties, the coverage must also include claims arising from the use of firearms. It is important to note that the completed form must accompany the licensure application or renewal form. Failure to provide the necessary information may result in processing delays. The form also includes declarations under penalties of perjury, ensuring the accuracy and completeness of the information provided.
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)
Filling out the De Ins Illinois form is an essential step in the licensing process. This form requires specific information from both the applicant and the insurance agent. Ensure that all sections are completed accurately to avoid delays in processing.
Once the form is completed, it should be submitted along with your application for licensure or renewal. Ensure that all information is accurate and complete to facilitate the processing of your application.
What is the De Ins Illinois form used for?
The De Ins Illinois form is a supporting document necessary for individuals seeking licensure under the Illinois Compiled Statutes. It ensures that applicants have the required liability insurance coverage as part of their application or renewal process for specific professions, including private detectives, private security personnel, and locksmiths.
Who needs to complete the De Ins Illinois form?
Both new applicants and those renewing their licenses must complete the De Ins Illinois form. The applicant fills out their section, while an authorized insurance agent must complete the remainder of the form, confirming the insurance coverage details.
What information is required from the applicant?
Applicants need to provide their name, date of birth, social security number, address, and telephone number. Additionally, they must record their profession name and code if they are new applicants. Renewal applicants should include their individual license numbers for the relevant acts.
What type of insurance is required?
Applicants must have comprehensive commercial general liability insurance in their name, with a minimum coverage of $1,000,000. This policy should cover bodily injury, property damage, and personal injury. If firearms are used in the course of employment, the policy must extend coverage to related claims.
What happens if I don’t complete this form?
Failure to complete the De Ins Illinois form may result in your application not being processed. It's essential to provide this information to ensure compliance with state regulations and to avoid delays in obtaining or renewing your license.
Is disclosing my insurance information mandatory?
While the disclosure of insurance information is voluntary, it is crucial for the processing of your application. Not providing this information could lead to complications or a denial of your application.
How do I submit the De Ins Illinois form?
The completed form must be submitted alongside your application for licensure or renewal. Ensure that all sections are filled out accurately and that the insurance agent has signed off on the necessary details.
What if my insurance policy changes?
If your insurance policy is terminated before its expiration date, the insurer must provide written notice to the Department of Financial and Professional Regulation at least 30 days prior to the cancellation. Keeping your insurance current is vital for maintaining your license.
What should I do if I have more questions about the form?
If you have further questions regarding the De Ins Illinois form, consider reaching out to the Department of Financial and Professional Regulation or your insurance agent. They can provide guidance and ensure you have the necessary information for a successful application.
Where can I find the De Ins Illinois form?
The De Ins Illinois form can typically be found on the official website of the Illinois Department of Financial and Professional Regulation. Make sure to download the most current version to avoid any issues during your application process.
Filling out the De Ins Illinois form can be a straightforward process, but several common mistakes can hinder your application. Understanding these pitfalls is crucial for ensuring a smooth licensure process.
One frequent error is incomplete information. Applicants often forget to fill in all required fields, such as the date of birth or social security number. Omitting even one detail can lead to delays or rejection of the application. Always double-check that every section is filled out completely.
Another mistake involves incorrect names. The name of the insured must match exactly as it appears on the application or renewal form. Any discrepancies can cause confusion and may result in the form being returned for correction. Ensure that names are spelled correctly and consistently throughout the application.
Many applicants also neglect to include the insurance details accurately. This includes the policy number and effective dates. Providing incorrect or outdated information can lead to complications in verifying coverage. Verify all insurance details with your agent before submission.
Additionally, applicants sometimes fail to sign the form. The declaration under penalties of perjury requires a signature, and without it, the form is incomplete. Make sure to sign and date the application to confirm the accuracy of the information provided.
Some people mistakenly submit the form without the required documentation. The De Ins form must be accompanied by proof of insurance, which is essential for processing. Ensure that you have all necessary documents ready when submitting your application.
Another common issue is using outdated forms. Regulations can change, and using an old version of the form may lead to complications. Always download the latest version from the official website to avoid this mistake.
Lastly, applicants often overlook contact information. Providing a daytime phone number is crucial for any follow-up questions or clarifications. Ensure that the number listed is accurate and that you can be reached during business hours.
By being aware of these common mistakes, applicants can improve their chances of a successful application process. Take the time to review your form carefully and consult with your insurance agent if needed.
When applying for licensure in Illinois, several forms and documents may accompany the De Ins Illinois form. These documents help ensure that all necessary information is provided and that applicants meet the required standards. Below is a list of commonly used forms that may be needed in conjunction with the De Ins Illinois form.
Each of these forms plays a vital role in the licensure process. Completing and submitting them accurately helps facilitate a smoother application experience.
The De Ins Illinois form shares similarities with several other documents required for licensure and insurance verification. Here are five such documents:
When filling out the De Ins Illinois form, attention to detail is crucial. Here are ten important guidelines to follow, along with some common pitfalls to avoid.
Following these guidelines can help streamline the application process and ensure compliance with Illinois regulations.
The following list outlines ten common misconceptions regarding the De Ins Illinois form, which is necessary for licensure under the Illinois Compiled Statutes.
Here are some important points to remember when filling out and using the De Ins Illinois form:
These points will help ensure that you complete the form accurately and meet all necessary requirements for licensure in Illinois.