Required Statements

Required statements for approved insurance provider-issued forms.

• The Collection of Information and Data (Privacy Act) Statement for Agents, Loss Adjusters and Policyholders and the
• The Non-Discrimination Statement must be included on any form the individual signs or provided to the individual on separate form, for each form that is signed by the individual. A copy must be maintained by the approved insurance provider (AIP).
• The Certification Statement must be included on any form that the insured signs that collects information from the insured (for example, application or acreage report). Not applicable to appraisal worksheets.

For more information, please refer to the current Document and Supplemental Standards Handbook (FCIC-24040).

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