No Loss notice used for reinstating cancelled automobile policies
If your Automobile policy has been cancelled for nonpayment you can contact our office to see if the Insurance company will reinstate the policy. Many of the companies will do so within a few days of the cancellation. To accomplish this you will need to pay the amount required at the time of cancellation and possible an additional amount to catch up plus sign a statement that no losses have occurred on the policy from the date of the cancellation to the date the policy would be reinstated. The following form can be used as the no loss form or you can use it as an example.
Date:   /  /
To : _____________________________________________________________________
                                                           (name of insurance company)
      _____________________________________________________________________
                                                         (address of insurance company)
Re : _____________________________________________________________________

                                                           (name of insurance company)

       
       _____________________________________________________________________

                                                                      (policy number)
Attention:
This is to confirm that to the best of my knowledge there have been no claims occurring 
that  involve my : ___________________________________________________________
                                                   (vehicles on policy)                                                         
from the _________________ cancellation to this date.
                    (date of cancellation)
Very Truly Yours,
_____________________________________________________________________

                                                                 (name of insured)
_____________________________________________________________________

                                                               (address of insured)