Get the free Affidavit by Broker and Insured Form

This document serves as an affidavit by a broker and the insured regarding the inability to procure required insurance from licensed insurers in Rhode Island, and the subsequent request to obtain

How to fill out affidavit by broker and

How to fill out Affidavit by Broker and Insured Form

1. Read the instructions provided with the Affidavit by Broker and Insured Form thoroughly.
2. Begin by filling out the basic information at the top of the form, including the names and contact details of the Broker and the Insured.
3. Clearly state the purpose of the affidavit and any relevant policy or claim numbers.
4. Provide a detailed description of the facts and circumstances that necessitate the affidavit.
5. Both the Broker and the Insured should review the information for accuracy.
6. Sign and date the affidavit at the specified sections, ensuring all signatures are in the correct places.
7. If required, have the affidavit notarized.
8. Submit the completed form to the relevant insurance provider or authority as instructed.

Who needs Affidavit by Broker and Insured Form?

1. The Affidavit by Broker and Insured Form is typically needed by individuals or entities involved in an insurance claim process.
2. Brokers and insured parties who need to clarify facts and provide declarations for claims or policy disputes require this form.
3. It may also be needed for compliance purposes during insurance audits.

For pdfFiller’s FAQs

What is Affidavit by Broker and Insured Form?

The Affidavit by Broker and Insured Form is a document used to verify the details of an insurance policy and confirm that the insured party is aware of their coverage.

Who is required to file Affidavit by Broker and Insured Form?

Typically, both the broker and the insured individual or entity are required to file the Affidavit by Broker and Insured Form to attest to the accuracy of the insurance policy details.

How to fill out Affidavit by Broker and Insured Form?

To fill out the form, both the broker and the insured should provide relevant information including names, policy numbers, and signatures, ensuring all sections are accurately completed as per the guidelines provided.

What is the purpose of Affidavit by Broker and Insured Form?

The purpose of the Affidavit by Broker and Insured Form is to formally declare the accuracy of the insurance policy details and to provide legal assurance to the insurance provider regarding the broker and insured's understanding of the terms.

What information must be reported on Affidavit by Broker and Insured Form?

The form must report information such as the names of the broker and insured, policy numbers, coverage details, and a declaration statement regarding the accuracy and completeness of the provided information.