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How to fill out excess line supplemental statement

Point by point instructions on how to fill out an excess line supplemental statement:

1. Begin by obtaining the necessary form for the excess line supplemental statement. This can often be obtained from your insurance provider or agent.
2. Fill out the required personal and contact information on the form. This may include your name, address, phone number, and policy number.
3. Provide a detailed description of the excess line coverage for which you are seeking additional information. Include any relevant policy details, such as the coverage amount and effective dates.
4. If applicable, include any supporting documentation or evidence to substantiate your claim for excess line coverage. This could include receipts, invoices, or other relevant paperwork.
5. Sign and date the excess line supplemental statement, acknowledging that the information provided is true and accurate to the best of your knowledge.
6. Submit the completed form to your insurance provider or agent, following any additional instructions they may have provided.

Who needs an excess line supplemental statement?

1. Individuals who have purchased excess line coverage for specific risks not covered by traditional insurance policies may need to fill out an excess line supplemental statement.
2. Businesses or organizations that have obtained excess line coverage to protect against unique or specialized risks may also require an excess line supplemental statement.
3. In some cases, insurance providers or agents may request an excess line supplemental statement as part of their due diligence process to ensure compliance with regulatory requirements and assess the suitability of coverage for the insured party.

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What is excess line supplemental statement?

The excess line supplemental statement is a document that provides additional information on the excess lines of insurance placed with non-admitted insurers.

Who is required to file excess line supplemental statement?

Insurance producers or surplus lines brokers who place excess lines of insurance are required to file the excess line supplemental statement.

How to fill out excess line supplemental statement?

The excess line supplemental statement can be filled out by providing the required information such as policy details, insured information, non-admitted insurer details, and other relevant data.

What is the purpose of excess line supplemental statement?

The purpose of the excess line supplemental statement is to provide regulatory authorities with additional information about the excess lines of insurance placed with non-admitted insurers.

What information must be reported on excess line supplemental statement?

The excess line supplemental statement requires reporting of information such as policy details, premiums, commission, insured details, non-admitted insurer details, and any additional information required by regulatory authorities.