Get the free Surplus Lines Statement (Form SL-8) - Agency Intermediaries, Inc.

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 Agency Intermediaries, Inc. P.O. Box

How to fill out surplus lines statement form

How to fill out surplus lines statement form:

1. Fill in your personal information: Start by providing your name, contact information, and any other relevant details required on the form. Make sure to double-check the accuracy of the information provided.
2. Identify the insured entity: Indicate the name and address of the entity that is being insured. This could be an individual, a business, or any other type of entity that requires coverage.
3. Provide details about the insurance coverage: Specify the type of insurance policy being applied for and provide all the necessary information related to the coverage. This may include policy limits, deductibles, and any additional endorsements or riders.
4. Disclose any previous or existing insurance: If there is any previous or existing insurance coverage in place, it is important to disclose this on the form. Include the details of the current policy, insurer's name, policy number, and effective dates.
5. Add information about the insurance broker or agent: If you're working with an insurance broker or agent, include their name, contact information, and any other required details. This will help establish a connection between the insured entity and the responsible insurance professional.
6. Provide signatures and dates: Ensure that the surplus lines statement form includes a section for signatures. All relevant parties, such as the insured entity and the insurance broker or agent, should sign and date the form to validate its accuracy and authenticity.

Who needs surplus lines statement form?

1. Insurance brokers or agents: Surplus lines statement forms are often required by insurance brokers or agents to comply with regulatory and legal requirements when arranging surplus lines coverage.
2. Insured entities seeking surplus lines coverage: Any individual or business that requires insurance coverage that cannot be obtained from licensed insurers may need to complete a surplus lines statement form. This form helps facilitate the placement of coverage with a surplus lines carrier.
3. Regulators and insurance authorities: Surplus lines statement forms are also relevant to regulators and insurance authorities who oversee the insurance industry. These forms provide critical information about surplus lines transactions and help ensure compliance with applicable laws and regulations.

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What is surplus lines statement form?

The surplus lines statement form is a document that must be filled out to report information on surplus lines insurance transactions.

Who is required to file surplus lines statement form?

Insurance companies or authorized surplus lines brokers are required to file the surplus lines statement form.

How to fill out surplus lines statement form?

To fill out the surplus lines statement form, you need to provide the required information regarding surplus lines insurance transactions.

What is the purpose of surplus lines statement form?

The purpose of the surplus lines statement form is to report and regulate surplus lines insurance transactions.

What information must be reported on surplus lines statement form?

The surplus lines statement form requires reporting information such as policy details, premium amounts, and insured parties.