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The De Ins Illinois form plays a crucial role in the licensing process for various professions, including private detectives, alarm personnel, and security professionals. This form is essential for applicants seeking licensure or renewal under the Illinois Compiled Statutes. To ensure a smooth application process, the applicant must fill out their personal information, including their name, date of birth, and social security number. An authorized insurance agent must then complete the remaining sections of the form. This includes providing details about the comprehensive general liability insurance policy, which must be held in the name of the individual licensee. The policy should offer a minimum coverage of $1,000,000, encompassing bodily injury, property damage, and personal injury. For those who carry firearms as part of their duties, the insurance must also cover claims related to the use of firearms. It is important to note that while disclosing information on this form is voluntary, failing to do so may hinder the processing of the application. The completed De Ins Illinois form must accompany the licensure application, ensuring that all necessary documentation is submitted for consideration.

De Ins Illinois Example

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)

Click for De Ins Illinois File

File Breakdown

Fact Name Details
Governing Law This form is governed by 225 ILCS 446/1 et seq. of the Illinois Compiled Statutes.
Voluntary Disclosure Providing information on this form is voluntary, but not completing it may delay processing.
Insurance Requirement The applicant must have comprehensive commercial general liability insurance in their name.
Submission Requirement The completed form must be submitted with the application for licensure or renewal.
Agent's Declaration The insurance agent must confirm that the policy meets state requirements and provide a signature.

Guide to Using De Ins Illinois

Filling out the De Ins Illinois form requires attention to detail and accuracy. This form is essential for individuals seeking licensure in various professional fields in Illinois. Follow these steps carefully to ensure that all required information is correctly provided.

  1. Complete the Applicant Section: Fill in your name exactly as it appears on your application.
  2. Date of Birth: Enter your date of birth in the format Month/Day/Year.
  3. Social Security Number: Provide your social security number in the specified format.
  4. Address: Write your complete address, including street, city, state, and ZIP code.
  5. New Applicants Only: Record your profession name and the corresponding three-digit profession code.
  6. Maiden or Given Surname: If applicable, provide your maiden name or given surname.
  7. Renewal Applicants: List each individual license number you hold under the relevant acts.
  8. Telephone Number: Include a daytime phone number where you can be reached.
  9. Signature: Sign and date the form, affirming the truthfulness of the information provided.

Once the applicant section is complete, the insurance agent will need to fill out the remaining parts of the form. This includes details about the insurance company and the policy itself. After both sections are filled out, submit the completed form along with your application for licensure or renewal.

  1. Insurance Company Information: The agent should provide the name of the insurance company.
  2. Authorized Agency/Producer: Include the name of the authorized agency or producer.
  3. Insurance Company Address: Fill in the home address of the insurance company.
  4. Agent's Business Address: Provide the street, city, state, and ZIP code of the agent's business.
  5. Policy Number: Enter the insured's policy number.
  6. Title or Type of Policy: Specify the title or type of insurance policy.
  7. Agent's Business Phone Number: Include the business telephone number of the agent.
  8. Effective Date of Policy: Record the policy's effective date in the format Month/Day/Year.
  9. Expiration Date of Policy: Enter the expiration date of the policy in the same format.

After all sections are completed, ensure that the agent signs and dates the form, confirming the policy meets the necessary requirements. This final step is crucial for the processing of your application.

Get Answers on De Ins Illinois

  1. 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, specifically 225 ILCS DE-INS 446/1 et. seg. This form ensures that applicants have the necessary liability insurance coverage, which is essential for their professional activities. By completing this form, applicants provide vital information that helps in the processing of their licensure applications.

  2. Who needs to complete the De Ins Illinois form?

    Both new applicants and those renewing their licenses must complete the De Ins Illinois form. New applicants should fill out the applicant section, while renewal applicants must verify their current insurance. It is crucial for the insurance to be in the name of the individual license holder, ensuring that the coverage is appropriate for their professional activities.

  3. What information is required from the applicant?

    Applicants must provide several key pieces of information, including:

    • Name of the insured (exactly as it appears on the application)
    • Date of birth
    • Social Security number
    • Address (street, city, state, ZIP code)
    • Profession name and three-digit profession code (for new applicants)
    • Maiden or given surname
    • Telephone number for daytime contact

    This information is essential for the processing of the application and must be accurate.

  4. What type of insurance coverage is required?

    Applicants must have a comprehensive commercial general liability insurance policy with a minimum coverage of $1,000,000. This policy should include:

    • Bodily injury liability
    • Property damage liability
    • Personal injury coverage

    If the licensee carries a firearm while on duty, the policy must also cover claims related to the use of firearms during employment. This is particularly important for those who manage agencies and allow employees to carry firearms.

  5. What happens if I do not submit the De Ins Illinois form?

    Failure to submit the De Ins Illinois form may result in the processing of your application being delayed or even denied. While the disclosure of information is voluntary, it is strongly recommended to complete and submit this form to ensure that your licensure application is considered without complications.

  6. How should the completed form be submitted?

    The completed De Ins Illinois form must be submitted along with your application for licensure or renewal. It is essential to ensure that all sections of the form are filled out accurately and completely before submission to avoid any processing issues.

  7. What should I do if my insurance policy changes?

    If there are any changes to your insurance policy, such as termination or modification, the insurance company is required to provide written notice to the Department of Financial and Professional Regulation at least 30 days prior to the cancellation. It is crucial to keep your insurance information up to date to maintain compliance with licensing requirements.

Common mistakes

When filling out the De Ins Illinois form, many applicants encounter common pitfalls that can lead to delays or complications in the licensing process. Understanding these mistakes can help ensure a smoother application experience.

One frequent error is not providing the exact name as it appears on the application. The form requires the name of the insured to match precisely with the name on the renewal or application form. If there are discrepancies, the application may be rejected, causing unnecessary frustration.

Another mistake involves the social security number. Applicants sometimes either omit this critical piece of information or make errors in the digits. This section is essential for identity verification, and any inaccuracies can result in the form being processed incorrectly or not at all.

Additionally, applicants often overlook the importance of the insurance policy details. This includes the policy number, effective dates, and the insurance company's name. Incomplete or incorrect information in these areas can lead to significant delays in the processing of the application. It is vital to double-check that all information is accurate and complete.

Furthermore, new applicants frequently forget to include their profession name and code. This information is crucial for categorizing the application correctly within the Illinois licensing system. Without it, the application may not reach the appropriate department for review.

Lastly, failing to provide a current contact number can create communication barriers. If the licensing department needs to reach the applicant for any reason, having an accurate daytime telephone number is essential. An outdated or incorrect number can lead to missed opportunities for clarification or additional information requests.

By being aware of these common mistakes, applicants can take proactive steps to ensure their De Ins Illinois form is completed accurately, ultimately leading to a more efficient licensing process.

Documents used along the form

When applying for licensure in Illinois, it is essential to have all necessary forms and documents in order. The De Ins Illinois form is a critical component of this process, but it often needs to be accompanied by other supporting documents to ensure a smooth application experience. Below is a list of documents commonly used alongside the De Ins Illinois form, each serving a specific purpose in the licensure process.

  • Application for Licensure or Renewal: This form is the primary application that must be filled out by the individual seeking licensure or renewal. It provides essential information about the applicant's background and qualifications.
  • Certificate of Insurance: This document verifies that the applicant has the required liability insurance coverage. It must meet specific standards, including a minimum coverage amount.
  • Proof of Identification: A government-issued ID, such as a driver’s license or passport, is needed to confirm the identity of the applicant. This helps prevent fraud and ensures accurate record-keeping.
  • Background Check Authorization: This form allows the relevant authorities to conduct a background check on the applicant. It is a crucial step in assessing the applicant's eligibility for licensure.
  • Fingerprint Submission Form: Required for certain professions, this form details the process for submitting fingerprints for a criminal background check. It helps ensure the safety and integrity of the profession.
  • Professional References: Applicants may need to provide a list of professional references who can vouch for their qualifications and character. This adds credibility to the application.
  • Continuing Education Certificates: For renewal applicants, proof of completed continuing education courses may be required. This demonstrates the applicant's commitment to staying current in their field.
  • Employment Verification Letter: This letter confirms the applicant's employment history and relevant experience in the field. It is often required to support the application.
  • Payment Form: This document is used to submit the required fees for the application process. Timely payment is essential to avoid delays.
  • Affidavit of Truthfulness: This sworn statement confirms that all information provided in the application is accurate and truthful. It is a legal requirement to ensure the integrity of the application process.

Having these documents prepared and submitted alongside the De Ins Illinois form can significantly enhance the chances of a successful application. Ensure that each document is completed accurately and submitted on time to avoid any unnecessary delays in the licensure process.

Similar forms

The De Ins Illinois form is essential for obtaining a license in Illinois. It shares similarities with several other important documents. Here are five documents that are comparable to the De Ins Illinois form:

  • Certificate of Insurance: This document serves as proof that an individual has the required insurance coverage. Like the De Ins Illinois form, it must include specific details about the insured and the insurance policy.
  • Application for Licensure: This form is necessary for individuals seeking to obtain or renew a license. Similar to the De Ins Illinois form, it requires personal information and may need to be submitted alongside other supporting documents.
  • Insurance Policy Declaration Page: This page summarizes the key details of an insurance policy. It is comparable to the De Ins Illinois form in that it provides essential information regarding coverage, including the insured's name and policy number.
  • Proof of Employment: This document verifies an individual's employment status and may be required for licensure. Like the De Ins Illinois form, it often necessitates confirmation from an authorized party, such as an employer or supervisor.
  • Renewal Application Form: This form is used when an individual is renewing their license. It shares similarities with the De Ins Illinois form, as both require updated information and may involve a review of existing qualifications and insurance coverage.

Dos and Don'ts

When filling out the De Ins Illinois form, there are important steps to follow to ensure your application is processed smoothly. Below is a list of things you should and shouldn't do.

  • Do complete the applicant section thoroughly before submitting the form.
  • Do ensure that the name of the insured matches exactly with the name on the application or renewal form.
  • Do provide accurate contact information, including a daytime telephone number where you can be reached.
  • Do include the required insurance details, such as policy number and effective dates.
  • Don't leave any sections blank; incomplete forms may not be processed.
  • Don't use a policy that does not meet the minimum coverage requirements of $1,000,000.
  • Don't forget to have your authorized insurance agent complete their section of the form.
  • Don't submit the form without verifying all information for accuracy and completeness.

Misconceptions

Understanding the De Ins Illinois form is crucial for anyone seeking licensure under the relevant Illinois statutes. However, several misconceptions can lead to confusion. Here are seven common misconceptions about this form:

  1. Completion of the form is optional. Many believe that filling out the De Ins Illinois form is not mandatory. In reality, it is a supporting document necessary for licensure consideration. Failure to complete it may result in processing delays.
  2. Insurance coverage can be in any name. Some applicants think they can submit insurance coverage in a business name or another individual's name. The insurance must be in the name of the individual license holder, not a company or another person.
  3. Only new applicants need to fill out the form. This is incorrect. Both new and renewal applicants must complete the form. Renewal applicants must also verify their current insurance information.
  4. The form can be submitted without an authorized agent's input. This is a misconception. The applicant must complete their section first, but the remainder must be filled out by an authorized insurance agent.
  5. Any insurance policy meets the requirements. Not all insurance policies qualify. The comprehensive commercial general liability insurance must provide a minimum of $1,000,000 in liability coverage and include specific protections.
  6. There is no need to notify the department if insurance is canceled. This is false. If the insurance policy is terminated before its expiration date, the insurer must notify the Department of Financial and Professional Regulation at least 30 days prior to cancellation.
  7. Providing personal information is mandatory. While applicants must complete certain sections, disclosing personal information, such as the Social Security number, is voluntary. However, not providing it may hinder the processing of the form.

By understanding these misconceptions, applicants can better navigate the licensure process in Illinois and ensure that they meet all necessary requirements.

Key takeaways

Filling out the De Ins Illinois form is an important step in the licensure process for various professions. Here are some key takeaways to help you navigate this form effectively:

  • Voluntary Disclosure: Providing certain information is voluntary, but failing to complete the form may delay processing.
  • Applicant's Responsibility: You must fill out the applicant section and ensure your insurance agent completes the rest.
  • Submission Requirement: The completed form must accompany your application for licensure or renewal.
  • Insurance Coverage: The insurance must be in your name as the individual license holder.
  • Comprehensive Coverage: You need a comprehensive commercial general liability insurance policy with a minimum of $1,000,000 coverage.
  • Policy Details: Include specific information such as policy number, effective dates, and agent details.
  • Firearm Coverage: If applicable, your policy should cover claims related to the use of firearms during your duties.
  • Agent's Declaration: The insurance agent must confirm that the policy meets all requirements and provide their signature.
  • Notice of Cancellation: If the policy is terminated early, the insurer must notify the Department of Financial and Professional Regulation 30 days in advance.

Understanding these points will help ensure that you complete the De Ins Illinois form accurately and efficiently, paving the way for a smoother licensure process.