The De Ins Illinois form is a crucial document required for individuals seeking licensure under the Illinois Compiled Statutes. This form must be completed by the applicant and their authorized insurance agent to ensure compliance with state regulations. To begin the process of obtaining your license, please fill out the form by clicking the button below.
The De Ins Illinois form is an essential document for individuals seeking licensure under the Illinois Compiled Statutes, specifically 225 ILCS DE-INS 446/1 et seq. This form serves as a supporting document that must be completed and submitted alongside the application for licensure or renewal. Applicants are required to fill out their personal information, including their name, date of birth, and social security number, as well as their address. For new applicants, there is a section to record the profession name and corresponding profession code. Additionally, the form mandates that an authorized insurance agent complete the insurance details, which include the name of the insurance company, policy number, and effective dates. It is important to note that the comprehensive commercial general liability insurance policy must provide a minimum of $1,000,000 in coverage, encompassing bodily injury, property damage, and personal injury. If the licensee carries a firearm while on duty, additional coverage for claims related to firearm use is also necessary. The form emphasizes the importance of accuracy and completeness, as any discrepancies may lead to processing delays. Lastly, both the applicant and the insurance agent must sign the form, affirming the truthfulness of the information provided.
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Understanding the De Ins Illinois form is crucial for anyone seeking licensure in the state. However, several misconceptions often arise. Here are nine common misunderstandings:
Being aware of these misconceptions can help streamline the application process and ensure compliance with Illinois regulations.
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, consider the following guidelines:
Additionally, avoid the following common mistakes:
Filling out the De Ins Illinois form is a straightforward process, but attention to detail is crucial. This form is a necessary component for those seeking licensure in Illinois, and it requires input from both the applicant and their insurance agent. Once completed, the form must be submitted along with your application for licensure or renewal.