Homepage Blank De Ins Illinois Form
Outline

The De Ins Illinois form plays a crucial role in the licensing process for various professions in the state, including private detectives and security personnel. It serves as a supporting document that must be completed alongside the application for licensure or renewal. The form requires applicants to provide essential information such as their name, date of birth, and social security number. Additionally, applicants must indicate their profession and provide the corresponding profession code. Importantly, the form also necessitates the involvement of an authorized insurance agent, who will fill out the insurance details, ensuring that the applicant has the required comprehensive commercial general liability insurance. This insurance must cover a minimum of $1,000,000 for bodily injury, property damage, and personal injury, extending to claims related to the use of firearms if applicable. Failure to complete this form accurately may lead to delays or denial in the licensing process, emphasizing the need for careful attention to detail.

Sample - De Ins Illinois Form

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

Form Information

Fact Name Fact Description
Governing Law This form is governed by 225 ILCS 446/1 et seq. of the Illinois Compiled Statutes.
Purpose Completion of the form is necessary for consideration for licensure under the specified statutes.
Voluntary Disclosure Disclosure of information on the form is voluntary; however, failure to comply may lead to non-processing.
Insurance Requirements The insurance must be comprehensive, commercial general liability with a minimum coverage of $1,000,000.
Submission Process The completed form must be submitted with the application for licensure or renewal.
Agent's Responsibilities The authorized insurance agent must complete the remainder of the form after the applicant fills out their section.

Detailed Guide for Filling Out De Ins Illinois

Filling out the De Ins Illinois form is an essential step for those seeking licensure in Illinois. Ensure that all information is accurate and complete to avoid processing delays. Follow the steps below to successfully complete the form.

  1. In the APPLICANT section, enter your name exactly as it appears on your application.
  2. Provide your DATE OF BIRTH in the format Month/Day/Year.
  3. Enter your SOCIAL SECURITY NUMBER.
  4. Fill in your ADDRESS including street, city, state, and ZIP code.
  5. If you are a NEW APPLICANT, record your profession name and three-digit profession code.
  6. Input your MAIDEN OR GIVEN SURNAME.
  7. If you are a RENEWAL APPLICANT or verifying current insurance, list each individual license number you hold under the relevant acts.
  8. Provide a TELEPHONE NUMBER where you can be reached during the day.
  9. Sign and date the form, confirming the accuracy of the information provided.

Next, the insurance company or authorized agent will need to complete their section of the form. This includes providing details about the insurance policy and confirming that it meets the necessary requirements. After both sections are filled out, submit the completed form with your application for licensure or renewal.

  1. Insurance company should provide the NAME OF INSURANCE COMPANY.
  2. Enter the NAME OF AUTHORIZED AGENCY/PRODUCER.
  3. Fill in the INSURANCE COMPANY HOME ADDRESS.
  4. Provide the NAME AND ADDRESS OF AGENT'S BUSINESS.
  5. Record the INSURED'S POLICY NUMBER.
  6. Indicate the TITLE OR TYPE OF POLICY.
  7. List the AGENT'S BUSINESS TELEPHONE NUMBER.
  8. Fill in the EFFECTIVE DATE OF POLICY and EXPIRATION DATE OF POLICY.
  9. Agent must sign and date the form, confirming the policy meets the requirements.

Obtain 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. It is necessary to provide proof of comprehensive commercial general liability insurance. This insurance must cover the individual license holder and ensure that they are protected against various liabilities while performing their professional duties.

  2. Who needs to complete the De Ins Illinois 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 should also provide their current insurance details. It is crucial that the completed form is submitted along with the application for licensure or renewal.

  3. What information is required on the form?

    The form requires several pieces of information, including:

    • Name of the insured (must match the application)
    • Date of birth
    • Social Security number
    • Address (street, city, state, ZIP code)
    • Profession name and code for new applicants
    • License numbers for renewal applicants
    • Contact telephone number

    Additionally, the insurance company and agent must provide their details, including the policy number, type of policy, effective dates, and coverage amounts.

  4. What are the insurance requirements for the De Ins Illinois form?

    The insurance policy must be a comprehensive commercial general liability insurance with a minimum coverage of $1,000,000. It should cover bodily injury liability, property damage, and personal injury. If the licensee carries a firearm during their work, the policy must also cover claims related to firearm use. This coverage extends to any employees authorized to carry firearms under the licensee's agency.

Common mistakes

Filling out the De Ins Illinois form can be a straightforward process, but many applicants make common mistakes that can delay their licensure. One frequent error is failing to ensure that the name of the insured matches exactly with the name on the application. This inconsistency can lead to processing issues, as the state requires precise information for verification.

Another common mistake involves neglecting to provide a complete and accurate date of birth. It's essential to double-check this information, as any discrepancies may raise red flags during the review process. Similarly, applicants often overlook the requirement to include their Social Security number. This detail is crucial for identification and verification purposes, and omitting it can result in a rejection of the form.

Applicants should also be cautious when filling out their address. A specific address is required, and any errors in the street name, city, or zip code can lead to complications. Moreover, new applicants frequently forget to reference the profession name and three-digit profession code, which are necessary for the application. This oversight can cause unnecessary delays in processing.

Another mistake that can occur is not providing a valid telephone number where the applicant can be reached during the day. This information is important for any follow-up questions or clarifications. Lastly, applicants sometimes neglect to have their authorized insurance agent complete the necessary sections of the form. This step is vital, as the agent’s information and signature validate the insurance coverage, which is a key component of the application.

By avoiding these common pitfalls, applicants can ensure a smoother application process. Paying attention to detail and double-checking all entries will save time and help secure the necessary licensure in Illinois.

Documents used along the form

When applying for licensure in Illinois, particularly in the fields governed by the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act, several forms and documents accompany the De Ins Illinois form. Each of these documents plays a crucial role in ensuring that your application is complete and meets the necessary legal requirements. Below is a list of these important forms and documents.

  • Application for Licensure or Renewal: This primary document is required to initiate the licensing process. It collects essential information about the applicant's background, qualifications, and the specific license being sought.
  • Certificate of Insurance: This document provides proof of the required liability insurance coverage. It must detail the policy number, effective dates, and coverage limits to ensure compliance with state regulations.
  • Authorization Form: Often required for the insurance agent to disclose information on behalf of the applicant. This form grants permission for the agent to share necessary details with the licensing authority.
  • Background Check Consent Form: This form allows the state to conduct a background check on the applicant. It typically includes personal information such as social security number and fingerprints.
  • Proof of Training or Certification: Depending on the profession, applicants may need to submit evidence of completed training programs or certifications relevant to their field.
  • Employment Verification Letters: These letters confirm the applicant's work history and experience in the relevant field. They should be from previous employers and outline the nature of the work performed.
  • Character References: Applicants may be required to provide references from individuals who can vouch for their character and professionalism. These references help establish credibility and trustworthiness.
  • Disclosure Statements: These statements may be necessary to disclose any past legal issues or disciplinary actions. Transparency is key in the licensing process.
  • Payment Receipt: A receipt or proof of payment for the application fee is essential. This document confirms that the applicant has fulfilled the financial obligation required for processing the application.

Submitting the correct forms and documents alongside the De Ins Illinois form is vital for a smooth application process. Each document serves a specific purpose and helps to verify that the applicant meets the necessary standards for licensure. Ensuring that all paperwork is complete and accurate will significantly enhance the chances of a successful application.

Similar forms

The De Ins Illinois form is essential for those seeking licensure in specific professions. It is similar to several other documents that also serve as proof of compliance and insurance coverage. Below is a list of documents that share similarities with the De Ins Illinois form:

  • Certificate of Insurance: Like the De Ins Illinois form, this document verifies that an individual has the required insurance coverage for their profession.
  • Professional License Application: Both documents are required for individuals seeking licensure, ensuring that all necessary information is provided for approval.
  • Insurance Policy Declaration Page: This page outlines the details of an insurance policy, similar to how the De Ins Illinois form requires specific policy information.
  • Proof of Liability Insurance: Just as the De Ins Illinois form demands proof of liability coverage, this document serves the same purpose for various professions.
  • State Licensing Board Application: This application often requires similar personal and insurance information, ensuring compliance with state regulations.
  • General Liability Insurance Policy: This policy provides coverage for claims related to bodily injury and property damage, mirroring the coverage requirements in the De Ins Illinois form.
  • Continuing Education Documentation: While primarily focused on education, this documentation may also require proof of insurance, similar to the De Ins Illinois form.
  • Renewal Application for Licensure: This form is necessary for renewing licenses and often requires similar information regarding insurance and personal details.
  • Employer Verification Letter: This letter can confirm an individual's employment status and may also address insurance coverage, paralleling the requirements of the De Ins Illinois form.

Each of these documents plays a vital role in ensuring that professionals meet the necessary standards for licensure and compliance within their respective fields.

Dos and Don'ts

When filling out the De Ins Illinois form, it is important to approach the task with care. Here are some essential dos and don’ts to keep in mind:

  • Do complete the applicant section accurately, ensuring your name matches exactly as it appears on your application.
  • Do provide your social security number and date of birth without any errors.
  • Do ensure that the insurance policy is in the name of the individual license holder.
  • Do submit the completed form with your application for licensure or renewal.
  • Don’t leave any required fields blank, as this may delay the processing of your application.
  • Don’t forget to have your authorized insurance agent complete their section of the form.

By following these guidelines, you can help ensure that your application is processed smoothly and efficiently.

Misconceptions

  • Misconception 1: The De Ins Illinois form is optional.
  • This form is mandatory for consideration of licensure. Without it, your application may not be processed.

  • Misconception 2: You can submit the form without insurance.
  • Insurance coverage is required. It must be in the name of the individual license holder.

  • Misconception 3: The insurance can be in a company name.
  • The comprehensive general liability insurance must be in the name of the individual licensee, not a business entity.

  • Misconception 4: You can fill out the form by yourself.
  • The applicant must complete their section, but an authorized insurance agent must fill out the remainder.

  • Misconception 5: There is no need for specific details about the insurance policy.
  • Details like the policy number, effective dates, and coverage type are essential and must be included.

  • Misconception 6: The form can be submitted at any time.
  • The completed form must accompany your application for licensure or renewal. Timing matters.

  • Misconception 7: The insurance amount can be less than $1,000,000.
  • A minimum of $1,000,000 liability coverage is required. This is non-negotiable.

  • Misconception 8: Personal injury coverage is not necessary.
  • Coverage must include bodily injury, property damage, and personal injury. All aspects are crucial.

  • Misconception 9: You don’t need to inform the Department if the policy is canceled.
  • If the policy is terminated before expiration, the insurer must provide written notice to the Department 30 days prior to cancellation.

Key takeaways

Filling out the De Ins Illinois form can seem daunting, but understanding its key components will make the process smoother. Here are some essential takeaways to keep in mind:

  • Mandatory for Licensure: Completing this form is a necessary step for anyone seeking licensure under Illinois law.
  • Voluntary Disclosure: While providing certain information is voluntary, not doing so may delay processing.
  • Applicant's Responsibility: The applicant must fill out their section before passing it to their authorized insurance agent.
  • Insurance Requirements: The insurance must be in the name of the individual license holder, specifically for comprehensive commercial general liability.
  • Accurate Information: Ensure that the name and details match exactly with what appears on your application or renewal form.
  • Contact Information: Provide a daytime phone number where you can be reached for any follow-up questions.
  • Agent's Role: The insurance agent must complete their section and confirm that the policy meets all required standards.
  • Policy Coverage: The insurance policy must cover bodily injury, property damage, and personal injury, especially if firearms are involved in your work.

By keeping these points in mind, you can ensure that your De Ins Illinois form is filled out correctly and submitted on time, paving the way for a smoother licensure process.