De Ins Illinois Template

The De Ins Illinois form is a crucial document for individuals seeking licensure in various professions under Illinois law. This form not only verifies the applicant's insurance coverage but also ensures compliance with state regulations. Completing this form accurately is essential for a smooth licensure process, so don't hesitate to fill it out by clicking the button below.

Table of Contents

The De Ins Illinois form plays a crucial role in the licensure process for professionals in various fields, including private detectives, security personnel, and locksmiths. This form is a supporting document required for individuals seeking licensure or renewal under the Illinois Compiled Statutes. It is essential for applicants to provide specific information, such as their name, date of birth, social security number, and address, ensuring that the details match their application. The form also necessitates the involvement of an authorized insurance agent, who must complete sections pertaining to the insurance policy. A comprehensive general liability insurance policy, with a minimum coverage of $1,000,000, is mandatory. This insurance must cover bodily injury, property damage, and personal injury, particularly if the licensee uses a firearm during their duties. Additionally, if the licensee oversees an agency, the policy must extend coverage for any employees carrying firearms. Timely submission of this form, along with the application, is vital, as failure to comply may lead to processing delays.

De Ins Illinois Sample

IMPORTANT NOTICE: Completion of this form is

necessary for consideration for licensure under 225 ILCS

446/1 et. seg. (Illinois Compiled Statutes). Disclosure of

this information is VOLUNTARY. However, failure to

comply may result in this form not being processed.

SUPPORTING DOCUMENT

DE-INS

CERTIFICATE OF INSURANCE

1. NAME OF INSURED (must be exactly as it appears on application,

renewal form of individual license.)

4. ADDRESS STREET, CITY, STATE, ZIP CODE (specific address

as noted on license)

6. MAIDEN OR GIVEN SURNAME

8. TELEPHONE NUMBER (where you can be reached during the day-

time)

Area Code ( ___ ___ ___ ) ___ ___ ___

___ ___ ___ ___

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.

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

C. INSURANCE COMPANY HOME ADDRESS:

STREET, CITY, STATE, ZIP CODE

H. EFFECTIVE DATE OF POLICY

Signature of Applicant/Licensee Date

Signature of Agent Date

IL486-1280 1/13 (DE)

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.

__ __ __ - __ __ - __ __ __ __

5. NEW APPLICANTS ONLY

REFER TO REFERENCE SHEET. Record profession name and three digit

profession code for which you are making Illinois application.

2. DATE OF BIRTH

Profession Name

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.

Profession Code

115 -

119 -

124 -

191 -

B. NAME OF AUTHORIZED AGENCY/PRODUCER

D. NAME AND ADDRESS OF AGENT'S BUSINESS: STREET, CITY,

STATE, ZIP CODE

I. EXPIRATION DATE OF POLICY

Area Code ( ___ ___ ___ ) ___ ___ ___

___ ___ ___ ___

E. INSURED'S POLICY NUMBER

G. AGENT'S BUSINESS TELEPHONE NUMBER

3. SOCIAL SECURITY NUMBER

Month Day Year

__ __ / __ __ / __ __ __ __

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.

F. TITLE OR TYPE OF POLICY

▼ De Ins Illinois PDF Form

Document Attributes

Fact Name	Description
Governing Law	This form is governed by the Illinois Compiled Statutes, specifically 225 ILCS 446/1 et seq.
Purpose of the Form	The DE Ins Illinois form is necessary for applicants seeking licensure or renewal under the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act.
Voluntary Disclosure	While completing this form is necessary, disclosing certain information is voluntary. However, failing to provide required details may lead to processing delays.
Insurance Requirements	The form mandates that applicants hold a comprehensive commercial general liability insurance policy with a minimum coverage of $1,000,000.
Submission Guidelines	Applicants must complete their section and have their authorized insurance agent fill out the remainder before submitting the form with their licensure application.

De Ins Illinois: Usage Instruction

Filling out the De Ins Illinois form is an important step in the licensing process. This form requires specific information from both the applicant and the insurance provider. It is essential to complete the form accurately and submit it along with your application for licensure or renewal.

Begin by entering the NAME OF INSURED as it appears on your application.
Fill in your DATE OF BIRTH in the format MM/DD/YYYY.
Provide your SOCIAL SECURITY NUMBER.
Write your ADDRESS, including street, city, state, and ZIP code.
If you are a NEW APPLICANT, refer to the reference sheet and record your profession name and three-digit profession code.
Enter your MAIDEN OR GIVEN SURNAME.
If you are a RENEWAL APPLICANT, list each individual license number you hold under the relevant acts.
Provide a TELEPHONE NUMBER where you can be reached during the day.
Sign and date the form to declare that the information is true and complete.
Next, the insurance company or agent must complete their section:
Enter the NAME OF INSURANCE COMPANY.
Fill in the NAME OF AUTHORIZED AGENCY/PRODUCER.
Provide the INSURANCE COMPANY HOME ADDRESS.
List the NAME AND ADDRESS OF AGENT'S BUSINESS.
Enter the INSURED'S POLICY NUMBER.
Fill in the TITLE OR TYPE OF POLICY.
Provide the AGENT'S BUSINESS TELEPHONE NUMBER.
Enter the EFFECTIVE DATE OF POLICY in MM/DD/YYYY format.
Finally, provide the EXPIRATION DATE OF POLICY in the same format.

Frequently Asked Questions

What is the purpose of the De Ins Illinois form?

The De Ins Illinois form is a supporting document required for individuals seeking licensure under the Illinois Compiled Statutes. It ensures that applicants provide proof of their comprehensive commercial general liability insurance, which is essential for their professional operations.
Who needs to complete this form?

Both new applicants and renewal applicants must complete this form. New applicants need to fill out their personal information and have their authorized insurance agent complete the rest. Renewal applicants must verify their current insurance and provide their individual license numbers.
What information is required from the applicant?

Applicants must provide the following details:
- Name (as it appears on the application)
- Date of birth
- Social Security number
- Address (street, city, state, zip code)
- Profession name and code (for new applicants)
- Maiden or given surname
- Telephone number
What type of insurance is required?

The form requires proof of comprehensive commercial general liability insurance with a minimum coverage of $1,000,000. This insurance must cover bodily injury liability, property damage, and personal injury. Additional coverage is necessary if the licensee carries a firearm while on duty.
What happens if I do not submit this form?

If the De Ins Illinois form is not submitted with your application for licensure or renewal, it may result in your application not being processed. Compliance is crucial for a smooth licensure experience.
How should the completed form be submitted?

The completed De Ins Illinois form should be submitted alongside your application for licensure or renewal. Ensure that all sections are filled out correctly to avoid any delays in processing.
What is the role of the insurance agent in this process?

The authorized insurance agent is responsible for completing the insurance-related sections of the form. They must confirm that the policy meets the necessary requirements and provide their signature, affirming the accuracy of the information provided.

Common mistakes

Filling out the De Ins Illinois form can be a straightforward process, but many individuals encounter pitfalls that can delay or complicate their application. One common mistake is not providing the exact name of the insured as it appears on the application or renewal form. This detail is crucial because any discrepancies can lead to processing issues. Ensure that the name matches perfectly, as even minor variations can cause the form to be rejected.

Another frequent error involves the social security number. Applicants often forget to double-check this important piece of information. A simple typo can result in significant delays in processing. It’s essential to enter the correct number accurately, as it is used to verify identity and eligibility. Take the time to confirm that all digits are entered correctly before submitting the form.

Many people also overlook the insurance policy details, particularly the effective and expiration dates. These dates must be filled in accurately to ensure that the insurance coverage is valid during the licensing period. If the dates are incorrect or missing, the form may not be processed, causing further delays. Always verify that the policy dates align with the requirements outlined in the form.

Finally, applicants sometimes fail to include the signature of the authorized agent or themselves, which is a critical step in the submission process. Without a signature, the form is incomplete and will not be accepted. It is advisable to review the form thoroughly to ensure all required signatures are present before submission. Taking these precautions can help facilitate a smoother application process.

Documents used along the form

The De Ins Illinois form is a crucial document for individuals seeking licensure in various professions within the state of Illinois. Along with this form, several other documents may be required to ensure a complete application process. Below is a list of these supporting documents, each accompanied by a brief description.

Application for Licensure or Renewal: This form initiates the process for obtaining or renewing a professional license. It requires personal information and details about the applicant's qualifications.
Certificate of Insurance: This document provides proof of the required liability insurance coverage. It must be issued in the name of the individual license holder and must meet specific coverage requirements.
Background Check Authorization: Applicants may need to submit a form granting permission for a background check. This is often a standard procedure to ensure public safety and compliance with state regulations.
Proof of Education or Training: Documentation that verifies the applicant's educational background or training relevant to the profession is often necessary. This may include diplomas, transcripts, or certificates.
Employment Verification: Some applications require proof of relevant work experience. This may include letters from previous employers or pay stubs that demonstrate the applicant's professional history.
Continuing Education Certificates: For renewal applicants, certificates showing completion of required continuing education courses may be necessary. This ensures that license holders remain knowledgeable about current practices and regulations.
Professional References: A list of references who can vouch for the applicant's qualifications and character may be required. These references should be familiar with the applicant's work in the relevant field.
Affidavit of Good Moral Character: Some licensing boards require an affidavit confirming that the applicant possesses good moral character. This may involve a notarized statement from a reputable individual in the community.
License Verification from Other States: If the applicant holds licenses in other states, verification of those licenses may be necessary. This helps to confirm the applicant's professional standing across jurisdictions.

Each of these documents plays a vital role in the licensure process, ensuring that applicants meet the necessary standards and requirements set forth by the state of Illinois. It is essential to gather and submit all required forms to facilitate a smooth application experience.

Similar forms

The De Ins Illinois form serves a specific purpose in the licensure process for various professions in Illinois. However, it shares similarities with several other important documents. Here are five documents that are comparable to the De Ins Illinois form, each serving its own unique role:

Certificate of Insurance: Like the De Ins Illinois form, a Certificate of Insurance verifies that an individual or business holds an active insurance policy. It outlines coverage details, ensuring compliance with industry standards.
Proof of Liability Insurance: This document provides evidence that a licensee has the required liability coverage. Similar to the De Ins Illinois form, it confirms that the insurance meets specific minimum requirements set by regulatory bodies.
Application for Professional License: Both the De Ins Illinois form and a typical professional license application require personal information, including the applicant's name and contact details. They also necessitate supporting documentation for approval.
Insurance Policy Declaration Page: This page summarizes the key details of an insurance policy, much like the De Ins Illinois form. It includes information about the insured, coverage limits, and effective dates, providing a clear overview of the policy.
Endorsement Form: An endorsement form modifies an existing insurance policy, similar to how the De Ins Illinois form is used to update or confirm insurance coverage for licensure. It can add or change coverage terms as needed.

Dos and Don'ts

When filling out the De Ins Illinois form, it is crucial to follow specific guidelines to ensure your application is processed smoothly. Here is a list of dos and don’ts to keep in mind:

Do complete the applicant section accurately before submitting it to your insurance agent.
Do ensure that the name of the insured matches exactly with the application or renewal form.
Do provide a valid telephone number where you can be reached during the day.
Do include proof of comprehensive commercial general liability insurance with a minimum coverage of $1,000,000.
Don't leave any sections of the form blank; all required fields must be filled out.
Don't submit the form without the authorized insurance agent’s signature and details.
Don't forget to check the expiration date of your insurance policy before submitting the form.
Don't neglect to inform your insurance company of any changes to your policy that could affect your coverage.

Adhering to these guidelines will help facilitate the processing of your application for licensure. Ensure that all information is accurate and complete to avoid any delays.

Misconceptions

When it comes to the De Ins Illinois form, several misconceptions often arise. Understanding these can help ensure a smoother application process for licensure. Here are four common misconceptions:

Completion of the form is optional. Many believe that filling out the De Ins Illinois form is not mandatory. However, this form is a supporting document necessary for consideration for licensure. Failure to submit it can result in delays or denial of your application.
Insurance coverage can be in a business name. Some applicants assume that they can list their insurance under their business name. In reality, the comprehensive commercial general liability insurance must be in the name of the individual license holder, not the business entity.
Only new applicants need to fill out the entire form. There is a misconception that only new applicants are required to complete all sections of the form. Renewal applicants must also provide current insurance information, ensuring that their coverage is up to date.
Providing personal information is mandatory. While it may seem that disclosing personal information like Social Security numbers is compulsory, the form states that this information is voluntary. However, not providing it may hinder the processing of your application.

Clarifying these misconceptions can help streamline the application process and ensure compliance with Illinois regulations.

Key takeaways

Filling out the De Ins Illinois form is an essential step in the licensure process. Here are some key takeaways to keep in mind:

Complete All Sections: Ensure that both the applicant and the authorized insurance agent fill out their respective sections accurately.
Insurance Requirements: The insurance policy must be in the name of the individual license holder and should provide a minimum of $1,000,000 in liability coverage.
Submission Timing: Submit the completed form along with your application for licensure or renewal. Incomplete submissions may delay processing.
Voluntary Disclosure: While providing certain information is voluntary, failing to do so may result in the form not being processed.
Policy Validity: If the insurance policy is terminated before its expiration date, the insurer must notify the relevant department 30 days prior to cancellation.

By following these guidelines, you can help ensure a smoother application process for your licensure in Illinois.