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Get the free E-167-2 Surplus Lines Broker Semi-Annual Statement & Premium Tax Form

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ARIZONA DEPARTMENT OF INSURANCE PREMIUM TAX UNIT DUE ON OR BEFORE SEPTEMBER 1, 2001, Phone: (602) 9128429 Fax: (602) 9128421 ARIZONA SURPLUS LINES BROKER SEMIANNUAL STATEMENT AND PREMIUM TAX REPORT
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How to fill out e-167-2 surplus lines broker

01
To fill out the e-167-2 surplus lines broker form, follow these steps:
02
Start by entering the required information in the header section of the form, such as your name, company name, and contact details.
03
Identify the type of coverage you are applying for and provide details about the insured party and the policy to be issued.
04
Fill in the section related to the broker, including the broker's license information, name, and contact details.
05
Provide information about the surplus lines broker if different from the regular broker.
06
Complete the sections regarding the insurance producer, insured party, and the premium charged.
07
Attach any additional documentation required, such as declarations pages, underwriting materials, or premium installment schedules.
08
Review the completed form for accuracy and ensure all mandatory fields have been filled out.
09
Submit the form according to the specified instructions, whether it is through an online portal, email, or physical mail.
10
Keep a copy of the filled-out form for your records.

Who needs e-167-2 surplus lines broker?

01
The e-167-2 surplus lines broker form is needed by insurance brokers who engage in surplus line transactions. Surplus lines refer to insurance coverage that is obtained from an insurance provider that is not licensed in the insured party's state. This type of coverage is typically sought when traditional insurance markets are unable to offer the desired coverage at reasonable rates or terms. Surplus lines brokers specialize in connecting clients with surplus lines insurers, facilitating the placement of unique or hard-to-place risks. Therefore, any insurance broker involved in surplus lines transactions needs to fill out the e-167-2 form as part of their regulatory requirements.

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