Get the free Surplus Lines Disclosure Form Instructions This form is designed to provide guidance...

Surplus Lines Disclosure Form Instructions This form is designed to provide guidance based on the statutory requirements for such form, and it has not been approved by the Florida Department of Financial

How to fill out surplus lines disclosure form

How to fill out surplus lines disclosure form:

1. Start by gathering all the necessary information. This includes the name and address of the insured, the policy number, the effective and expiration dates of the policy, and the insurer's name and address.
2. Next, carefully read through the form and ensure that you understand all the questions and statements. It's important to provide accurate information to avoid any potential legal issues.
3. Begin filling out the form by providing the required information. This may include details about the insured's business, the type of policy being issued, and any other relevant information.
4. Pay close attention to any specific requirements or instructions mentioned in the form. This may include providing additional documents, such as proof of diligent effort to obtain coverage from admitted insurers.
5. Double-check all the information you have entered to make sure it is accurate and complete. Reviewing the form before submission can help prevent any mistakes or missing details.
6. Once you have completed the form, sign and date it accordingly. Make sure to read any statements or disclaimers before signing to affirm that you understand and agree to the terms.

Who needs a surplus lines disclosure form:

1. Individuals or businesses seeking insurance coverage that is not available from admitted insurers may need a surplus lines disclosure form. Admitted insurers are insurance companies that are licensed to operate in a particular state and are subject to regulation by that state's insurance department.
2. Surplus lines insurance covers risks that standard insurers may not be willing to underwrite or for which coverage is not readily available in the admitted market. Examples of risks that may require surplus lines coverage include high-value homes, unique or specialized businesses, and hard-to-place risks.
3. The surplus lines disclosure form is typically required by state insurance regulators to inform policyholders that they are obtaining coverage from a non-admitted insurer. It serves to disclose that certain protections provided by the state guarantee fund, such as coverage for policyholder losses in the event of insurer insolvency, may not be available for surplus lines policies.
4. The form may also serve as proof that the insured made a diligent effort to obtain coverage from admitted insurers before seeking surplus lines coverage. This can help demonstrate that adequate market alternatives were explored before resorting to a non-admitted insurer.
5. Depending on local regulations, the surplus lines disclosure form may need to be completed by the insured, their insurance agent, or both. It is important to consult with insurance professionals or state insurance departments for specific requirements based on your location and the nature of your insurance needs.

For pdfFiller’s FAQs

What is surplus lines disclosure form?

The surplus lines disclosure form is a document that must be submitted by insurance brokers when placing coverage with non-admitted insurers.

Who is required to file surplus lines disclosure form?

Insurance brokers are required to file surplus lines disclosure form.

How to fill out surplus lines disclosure form?

The surplus lines disclosure form can be filled out by providing information about the insured, description of coverage, premium amount, and details of the non-admitted insurer.

What is the purpose of surplus lines disclosure form?

The purpose of surplus lines disclosure form is to ensure compliance with insurance regulations and provide transparency regarding the placement of coverage with non-admitted insurers.

What information must be reported on surplus lines disclosure form?

Information such as insured's name, policy details, premium amount, and non-admitted insurer's details must be reported on surplus lines disclosure form.

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