Get the free Surplus Lines Disclosure Form Instructions

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. Obtain the form: The surplus lines disclosure form can typically be obtained from your insurance broker or agent. You may also find it on the website of your state's insurance department.
2. Read the instructions: Before filling out the form, carefully read the instructions provided. This will help you understand the purpose of the form and any specific requirements or guidelines.
3. Provide accurate information: Ensure that you accurately fill in all the required fields on the form. This may include details such as the insured's name, policy number, and coverage information.
4. Disclose surplus lines information: The purpose of the form is to disclose that the insurance coverage is being sourced from the surplus lines market. Therefore, you will need to provide information about the surplus lines insurer, including their name, address, and policy number.
5. Sign and date the form: Once you have completed filling out the form, make sure to sign and date it. This signifies that the information provided is correct and that you understand the nature of the surplus lines coverage.
6. Submit the form: After thoroughly reviewing the form for accuracy, submit it as per the instructions provided. This may involve sending it to your insurance broker or agent, or directly to the appropriate insurance regulatory authority in your state.

Who needs surplus lines disclosure form?

1. Insurance brokers and agents: Brokers and agents who procure insurance coverage from the surplus lines market on behalf of their clients need to fill out and disclose the surplus lines information on the form.
2. Insured individuals or businesses: If you, as an insured, are obtaining coverage from the surplus lines market, you will need to complete the surplus lines disclosure form to comply with regulatory requirements.
3. Insurance regulatory authorities: State insurance departments or regulatory authorities may require the surplus lines disclosure form to be submitted for monitoring and oversight purposes. They may use this information to track surplus lines activity within their jurisdiction.

For pdfFiller’s FAQs

What is surplus lines disclosure form?

Surplus lines disclosure form is a form that must be completed by insurance agents or brokers when placing insurance coverage with a non-admitted or unauthorized insurer.

Who is required to file surplus lines disclosure form?

Insurance agents or brokers are required to file surplus lines disclosure form.

How to fill out surplus lines disclosure form?

Surplus lines disclosure form can be filled out by providing the required information about the insured, coverage, and the non-admitted insurer.

What is the purpose of surplus lines disclosure form?

The purpose of surplus lines disclosure form is to disclose to the insured that the insurance coverage is being placed with a non-admitted insurer.

What information must be reported on surplus lines disclosure form?

The surplus lines disclosure form must include information about the insured, the coverage being placed, and the non-admitted insurer.

Where do I find surplus lines disclosure form?

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