RI Affidavit by Broker and Insured Form free printable template

Department of Business Regulation 233 Richmond Street Providence, RI 02903 Affidavit by Broker and Insured Form AFFIDAVIT BY BROKER I swear under penalty of perjury as follows. I am a Surplus Line

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How to fill out RI Affidavit by Broker and Insured Form

1. Obtain the RI Affidavit by Broker and Insured Form from the appropriate regulatory authority or website.
2. Fill in the basic information of the broker, including name, address, and license number.
3. Complete the insured's information, such as name, address, and policy number.
4. Clearly state the purpose of the affidavit and any relevant details regarding the insurance coverage.
5. Include the broker's signature and date at the bottom of the form.
6. If required, obtain the signature of the insured as well.
7. Submit the completed form to the relevant authority or organization as instructed.

Who needs RI Affidavit by Broker and Insured Form?

1. Brokers who are facilitating insurance on behalf of clients.
2. Insured individuals who need to validate their insurance coverage.
3. Any party involved in the insurance transaction requiring formal documentation to ensure compliance.

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What is RI Affidavit by Broker and Insured Form?

The RI Affidavit by Broker and Insured Form is a document that certifies and verifies information related to an insurance transaction. It typically includes declarations by the broker and the insured regarding the terms of the insurance policy.

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

The broker handling the insurance transaction and the insured party are both required to file the RI Affidavit by Broker and Insured Form to confirm the details of the insurance coverage.

How to fill out RI Affidavit by Broker and Insured Form?

To fill out the RI Affidavit by Broker and Insured Form, both parties need to provide their identifying information, policy details, and affirm the accuracy of the information by signing the form. Specific instructions may be provided by the issuing authority.

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

The purpose of the RI Affidavit by Broker and Insured Form is to ensure transparency and accountability in insurance transactions by verifying the accuracy of the information provided by the broker and insured.

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

The RI Affidavit by Broker and Insured Form must report information such as the names and addresses of the broker and insured, details of the insurance policy, dates, and any relevant endorsements or associated documentation.