Get De Ins Illinois Form

Get De Ins Illinois Form

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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Structure

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.

De Ins Illinois Preview

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

Area Code ( ___ ___ ___ ) ___ ___ ___ _ ___ ___ ___ ___

__ __ / __ __ / __ __ __ __

__ __ / __ __ / __ __ __ __

Month Day

Year

Month Day

Year

 

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)

Document Data

Fact Name Description
Governing Law This form is governed by the Illinois Compiled Statutes, specifically 225 ILCS DE-INS 446/1 et seq.
Purpose The form serves as a supporting document necessary for licensure consideration in Illinois.
Voluntary Disclosure Providing the requested information is voluntary; however, non-compliance may lead to processing issues.
Applicant Responsibilities The applicant must complete their section and have an authorized insurance agent fill out the remainder.
Insurance Requirements Insurance must be in the name of the individual license holder and include comprehensive general liability coverage.
Minimum Coverage A minimum of $1,000,000 in liability insurance is required, covering bodily injury, property damage, and personal injury.
Agent's Declaration The authorized agent must declare that the insurance policy meets state requirements and provide true statements.
Notice of Cancellation If the insurance policy is terminated, the insurer must notify the Department of Financial and Professional Regulation 30 days prior to cancellation.

How to Use De Ins Illinois

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.

  1. Complete the Applicant Section: Fill in your name exactly as it appears on your application.
  2. Provide Your Date of Birth: Enter your date of birth in the format MM/DD/YYYY.
  3. Enter Your Social Security Number: Write your social security number in the designated format.
  4. Fill in Your Address: Include your complete street address, city, state, and ZIP code.
  5. New Applicants Only: Record the profession name and three-digit profession code for which you are applying.
  6. Maiden or Given Surname: If applicable, provide your maiden name or given surname.
  7. Renewal Applicants: List each individual license number held under the relevant acts.
  8. Provide Your Telephone Number: Include a daytime contact number with area code.
  9. Sign and Date: The applicant must sign and date the form, confirming the information is accurate.
  10. Insurance Company Section: The authorized insurance agent must fill out their section, providing details about the insurance policy.
  11. Agent's Signature: The insurance agent must sign and date the form, certifying that the policy meets the necessary requirements.

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.

Key Facts about De Ins Illinois

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.

Common mistakes

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.

Documents used along the form

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.

  • Application for Licensure or Renewal: This form must be completed and submitted along with the De Ins Illinois form. It gathers essential information about the applicant's qualifications and background.
  • Certificate of Insurance: This document serves as proof of the applicant's liability insurance coverage. It should detail the policy's effective dates and coverage limits, ensuring compliance with state requirements.
  • Background Check Authorization Form: This form authorizes the state to conduct a background check on the applicant. It is a crucial step in assessing the applicant's suitability for licensure.
  • Continuing Education Documentation: Applicants may need to provide proof of completed continuing education courses. This documentation ensures that licensees stay informed about industry standards and practices.

Each of these forms plays a vital role in the licensure process. Completing and submitting them accurately helps facilitate a smoother application experience.

Similar forms

The De Ins Illinois form shares similarities with several other documents required for licensure and insurance verification. Here are five such documents:

  • Certificate of Insurance: This document verifies that an individual has the required insurance coverage. Like the De Ins Illinois form, it includes details about the insured, policy number, and coverage limits.
  • Application for Licensure: This form is submitted when seeking a professional license. It requires personal information and details about qualifications, similar to the applicant section of the De Ins Illinois form.
  • Insurance Policy Declaration Page: This page summarizes the coverage and terms of an insurance policy. It parallels the De Ins Illinois form by confirming that the insurance meets state requirements.
  • Renewal Application Form: This document is used to renew an existing license. It often requires updated information, just like the renewal section of the De Ins Illinois form for current license holders.
  • Proof of Professional Liability Insurance: This is a specific document showing that a professional carries liability insurance. It is similar to the De Ins Illinois form in that it must meet specific coverage requirements set by the state.

Dos and Don'ts

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.

  • Do ensure that the name of the insured matches exactly with the name on the application.
  • Do provide a valid telephone number where you can be reached during the day.
  • Do include the date of birth and social security number as required.
  • Do confirm that the insurance policy meets the minimum coverage requirements of $1,000,000.
  • Do have your authorized insurance agent complete the necessary sections of the form.
  • Don't leave any sections blank; incomplete forms may lead to processing delays.
  • Don't forget to sign and date the form, as this is necessary for validation.
  • Don't submit the form without ensuring that all information is correct and complete.
  • Don't use an outdated version of the form; always check for the most current version.
  • Don't assume that the insurance information is optional; it is required for licensure consideration.

Following these guidelines can help streamline the application process and ensure compliance with Illinois regulations.

Misconceptions

The following list outlines ten common misconceptions regarding the De Ins Illinois form, which is necessary for licensure under the Illinois Compiled Statutes.

  • Completion is Optional: Some individuals believe that filling out the De Ins Illinois form is optional. In reality, it is a required supporting document for licensure consideration.
  • Insurance Information is Mandatory: There is a misconception that all information on the form must be disclosed. However, while some details are necessary, disclosing certain information is voluntary.
  • Only New Applicants Need to Complete the Form: Many think that only new applicants need to fill out the form. Renewal applicants must also submit the form as part of their renewal process.
  • Any Type of Insurance is Acceptable: It is incorrect to assume that any insurance policy suffices. The form specifically requires comprehensive commercial general liability insurance.
  • Insurance Can Be in Any Name: Some believe that the insurance policy can be in any name. The insurance must be in the name of the individual license holder.
  • Form Submission is Not Time-Sensitive: There is a belief that submission timing does not matter. In fact, the completed form must be submitted with the application for licensure or renewal.
  • Only Liability Insurance is Required: Some individuals think that only liability insurance is necessary. The policy must cover bodily injury, property damage, and personal injury, among other aspects.
  • Coverage is Not Required for Firearm Use: It is a misconception that liability coverage does not need to extend to firearm use. If a licensee carries a firearm, coverage must include claims related to its use.
  • Agents Do Not Need to Sign the Form: Some believe that the agent's signature is unnecessary. The form requires the agent to declare that the policy meets the necessary requirements.
  • Cancellation Notices are Not Required: There is a misconception that insurers do not need to inform the Department of Financial and Professional Regulation about policy cancellations. In fact, written notice is required 30 days prior to cancellation.

Key takeaways

Here are some important points to remember when filling out and using the De Ins Illinois form:

  • Complete the Applicant Section: The applicant must fill out their personal details, including name, date of birth, and social security number.
  • Insurance Agent's Role: After the applicant completes their section, an authorized insurance agent must fill out the rest of the form.
  • Submission Requirement: This form must be submitted along with your application for licensure or renewal.
  • Insurance Policy Details: The insurance must be in the name of the individual license holder and must provide comprehensive coverage.
  • Minimum Coverage: The policy should have a minimum liability coverage of $1,000,000, including bodily injury and property damage.
  • Firearm Coverage: If the licensee carries a firearm, the policy must cover claims related to its use during employment.
  • Renewal Applicants: Those renewing their license need to provide their individual license numbers under the relevant acts.
  • Agent's Declaration: The insurance agent must declare that the policy meets all requirements and provide their signature.
  • Notice of Cancellation: If the insurance policy is canceled before expiration, the insurer must notify the Department 30 days in advance.

These points will help ensure that you complete the form accurately and meet all necessary requirements for licensure in Illinois.