Get the free Surplus Lines Statement (Form SL-8) State of Connecticut Insurance Department (Rev

Reset Form Control No. Surplus Lines Statement (Form SL-8) State of Connecticut Insurance Department (Rev. 07/2013) 1. Name and Address of Surplus Lines Broker 2. Producing Agent (not agency) 2a.

How to fill out surplus lines statement form

How to fill out surplus lines statement form:

1. Obtain the form: The surplus lines statement form can typically be obtained from the state insurance department or downloaded from their website.
2. Enter policy information: Provide the necessary information about the insurance policy for which you are filling out the form. This includes the policy number, effective dates, and coverage details.
3. Identify the insured: Clearly identify the insured party by providing their name, address, and any other requested information.
4. Disclose the surplus lines broker: If you are using a surplus lines broker, provide their name, address, and contact information.
5. Report premium information: Enter the total premium amount for the policy and indicate how it was calculated, including any fees or charges.
6. Declare surplus lines taxes: Depending on the state, you may be required to pay surplus lines taxes. Fill in the appropriate tax amount and include any supporting documentation, such as tax calculations or receipts.
7. Sign and date: Review the form for accuracy and completeness, then sign and date it to certify that the information provided is true and accurate.
8. Submit the form: Once the form is filled out and signed, submit it to the state insurance department or the designated authority. Retain a copy for your records.

Who needs surplus lines statement form:

1. Insurance brokers: Surplus lines statement forms are typically required to be completed by insurance brokers who are placing coverage with non-admitted insurers.
2. Insured parties: The insured parties, or policyholders, may also need to provide certain information on the surplus lines statement form, such as their contact details and policy information.
3. State insurance departments: Surplus lines statement forms are used by state insurance departments to monitor and regulate the placement of insurance coverage with non-admitted insurers.

For pdfFiller’s FAQs

What is surplus lines statement form?

Surplus lines statement form is a document used to report surplus lines insurance transactions.

Who is required to file surplus lines statement form?

Insurance agents and brokers who deal with surplus lines insurance are required to file surplus lines statement form.

How to fill out surplus lines statement form?

Surplus lines statement form can be filled out by providing information about surplus lines insurance transactions including premiums, insured parties, and coverage details.

What is the purpose of surplus lines statement form?

The purpose of surplus lines statement form is to report surplus lines insurance transactions to regulatory authorities.

What information must be reported on surplus lines statement form?

Information such as premiums, insured parties, and coverage details must be reported on surplus lines statement form.

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