Get the free BSURPLUS LINESb STATEMENT OF PREMIUMS AND bTAXb bb

STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE SURPLUS LINES DIVISION 500 James Robertson Parkway, 4th Floor Nashville, TN 372431132 ×615× 7411756 SURPLUS LINES STATEMENT OF PREMIUMS AND

How to fill out bsurplus linesb statement of

How to fill out a surplus lines statement:

1. Understand the purpose of the surplus lines statement: A surplus lines statement is a document that provides information about the insurance coverage obtained from an insurer that is not licensed in the insured's state. It is usually required by state insurance regulators.
2. Gather the necessary information: To fill out the surplus lines statement, you will need details about the insurance policy you obtained from the non-licensed insurer. This includes the policy number, effective dates, limits of coverage, and any additional endorsements or riders.
3. Determine the required format: Different states may have different formats for their surplus lines statements. Make sure you are aware of the specific requirements of your state. Generally, surplus lines statements include information about the insured, the insurer, the policy details, and the premium paid.
4. Provide information about the insured: Include the legal name, address, and contact details of the insured. You may also need to provide details about the type of business or industry the insured operates in.
5. Include information about the insurer: Provide the name, address, and contact details of the non-licensed insurer. If applicable, include the insurer's NAIC number or other identification numbers.
6. Outline the policy details: Fill in the policy number, effective dates of coverage, and any other relevant information such as the type of coverage, policy limits, deductibles, and exclusions. If there are any additional endorsements or riders, make sure to include them as well.
7. Calculate and report the premium: Include the total premium paid for the policy. If there are any taxes or fees associated with the surplus lines transaction, report them separately.
8. Sign and date the statement: Once you have completed all the required information, sign and date the surplus lines statement. This confirms that the information provided is accurate and complete.

Who needs a surplus lines statement:

Any insured individual or business that has obtained insurance coverage from a non-licensed insurer may need to complete a surplus lines statement. This requirement is usually mandated by state insurance regulators to ensure transparency and compliance with laws regarding surplus lines insurance. Examples of businesses that commonly require surplus lines coverage include construction companies, transportation companies, and high-risk industries where traditional insurance markets may not provide adequate coverage options. It is recommended to consult with an insurance professional or legal advisor to determine if you need to complete a surplus lines statement based on your specific insurance arrangements.

For pdfFiller’s FAQs

What is surplus lines statement of?

Surplus lines statement is a report submitted by insurance companies to provide information on surplus lines transactions.

Who is required to file surplus lines statement of?

Insurance companies authorized to transact surplus lines insurance are required to file surplus lines statement.

How to fill out surplus lines statement of?

Surplus lines statement can be filled out by providing information on surplus lines insurance transactions in the specified format provided by the regulatory authority.

What is the purpose of surplus lines statement of?

The purpose of surplus lines statement is to ensure transparency and compliance with regulations in surplus lines insurance transactions.

What information must be reported on surplus lines statement of?

Information such as premium volume, taxes, fees, and commissions related to surplus lines insurance transactions must be reported on surplus lines statement.

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