Form 8307 "Request for Unlicensed Adjuster Representing an Insurer to Adjust Losses Resulting From a Catastrophe" - Kentucky

What Is Form 8307?

This is a legal form that was released by the Kentucky Department of Insurance - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2009;
  • The latest edition provided by the Kentucky Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 8307 by clicking the link below or browse more documents and templates provided by the Kentucky Department of Insurance.

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Download Form 8307 "Request for Unlicensed Adjuster Representing an Insurer to Adjust Losses Resulting From a Catastrophe" - Kentucky

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Commonwealth of Kentucky
CATLOSS Form #8307 (02-2009)
Department of Insurance
Insurer Name:
P.O. Box 517, Frankfort, KY 40602
CAT LOSS #:
Insurer FEIN:
http://insurance.ky.gov/
Date of CAT LOSS:
KOIAgentLicensingMail@ky.gov
REQUEST FOR UNLICENSED ADJUSTER REPRESENTING AN INSURER TO ADJUST LOSSES RESULTING FROM A CATASTROPHE
In order to send unlicensed Adjusters into the Commonwealth of Kentucky to adjust the losses from a “declared” catastrophe situation, you must comply with the outlined
provisions of Kentucky Insurance Laws and Regulations. KRS 304.9-430 and 806 KAR 9:120 permit unlicensed adjusters into Kentucky based on the following: “An unlicensed
adjuster sent into this state on behalf of an insurer for the adjustment of a series of losses resulting from a catastrophe common to all such losses shall be permitted to do so without
being licensed in Kentucky for a period not exceeding ninety (90) consecutive days, which period may be extended by the commissioner for good cause shown.”
Adjusters who have complied with the following, shall be allowed in Kentucky to adjust CAT LOSS Claims:
Insurer certifies the adjuster is qualified by passing any state insurance regulatory adjuster examination, or
Insurer certifies the adjuster is employed by or contracted to act as a claims adjuster on behalf of insurer.
(WARNING – an unlicensed adjuster may not be sent into the state to adjust claims until this information has been filed with and approved by Kentucky Department of Insurance.
Confirmation of approval will be made by phone to the authorized insurer representative, indicated below, with a follow-up approval mailed to the address noted.)
Name of Unlicensed Adjuster
Social Security Number
Has Qualified by Exam in
Qualified by Employment or
Starting Date for CAT
Which State?
Contract for Which Insurer?
LOSS Claims Adjusting
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, BY SIGNING THIS FORM, I AM CERTIFYING THE ADJUSTERS LISTED HAVE MET THE
QUALIFICATIONS INDICATED AND I AM AUTHORIZED TO SIGN THIS FORM ON BEHALF OF THE INSURER INDICATED ABOVE.
Signature _____________________________________________________
Printed Name:
Title:
Date:
Phone Number:
Email Address:
Physical Street Address, City, State, ZIP:
Commonwealth of Kentucky
CATLOSS Form #8307 (02-2009)
Department of Insurance
Insurer Name:
P.O. Box 517, Frankfort, KY 40602
CAT LOSS #:
Insurer FEIN:
http://insurance.ky.gov/
Date of CAT LOSS:
KOIAgentLicensingMail@ky.gov
REQUEST FOR UNLICENSED ADJUSTER REPRESENTING AN INSURER TO ADJUST LOSSES RESULTING FROM A CATASTROPHE
In order to send unlicensed Adjusters into the Commonwealth of Kentucky to adjust the losses from a “declared” catastrophe situation, you must comply with the outlined
provisions of Kentucky Insurance Laws and Regulations. KRS 304.9-430 and 806 KAR 9:120 permit unlicensed adjusters into Kentucky based on the following: “An unlicensed
adjuster sent into this state on behalf of an insurer for the adjustment of a series of losses resulting from a catastrophe common to all such losses shall be permitted to do so without
being licensed in Kentucky for a period not exceeding ninety (90) consecutive days, which period may be extended by the commissioner for good cause shown.”
Adjusters who have complied with the following, shall be allowed in Kentucky to adjust CAT LOSS Claims:
Insurer certifies the adjuster is qualified by passing any state insurance regulatory adjuster examination, or
Insurer certifies the adjuster is employed by or contracted to act as a claims adjuster on behalf of insurer.
(WARNING – an unlicensed adjuster may not be sent into the state to adjust claims until this information has been filed with and approved by Kentucky Department of Insurance.
Confirmation of approval will be made by phone to the authorized insurer representative, indicated below, with a follow-up approval mailed to the address noted.)
Name of Unlicensed Adjuster
Social Security Number
Has Qualified by Exam in
Qualified by Employment or
Starting Date for CAT
Which State?
Contract for Which Insurer?
LOSS Claims Adjusting
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, BY SIGNING THIS FORM, I AM CERTIFYING THE ADJUSTERS LISTED HAVE MET THE
QUALIFICATIONS INDICATED AND I AM AUTHORIZED TO SIGN THIS FORM ON BEHALF OF THE INSURER INDICATED ABOVE.
Signature _____________________________________________________
Printed Name:
Title:
Date:
Phone Number:
Email Address:
Physical Street Address, City, State, ZIP: