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SpeedyTemplate. com/ NOTICE The language and format of this Form must not be altered. FORM 1263. 1 REVISED 2003 May be reproduced for future use. Seq. L.R.S. 22 1257 states that certain insurance coverages that cannot be procured from authorized insurers may be procured from unauthorized insurers provided that the insurance is procured through a licensed surplus lines producer. I also acknowledge and have been expressly advised by the producer above that in the event of insolvency of the...

How to fill out louisiana authorized non-admitted affidavit

How to fill out louisiana authorized non-admitted affidavit

1. Obtain a copy of the Louisiana authorized non-admitted affidavit form.
2. Read through the instructions and requirements outlined in the form.
3. Gather all the necessary information and supporting documents needed to complete the affidavit.
4. Fill out the personal information section accurately, providing your name, address, contact information, and any other details required.
5. Provide details about the non-admitted insurance company, including their name, address, contact information, and any relevant policy information.
6. Answer any questions or statements on the form, ensuring that your responses are truthful and accurate.
7. Attach any supporting documents required, such as proof of insurance coverage, financial statements, or other relevant paperwork.
8. Review the completed affidavit for any errors or missing information.
9. Sign and date the affidavit in the designated spaces.
10. Submit the completed Louisiana authorized non-admitted affidavit to the appropriate authority or insurance department.

Who needs louisiana authorized non-admitted affidavit?

1. Any individual or entity that operates as a non-admitted insurance company in the state of Louisiana needs to fill out the authorized non-admitted affidavit.
2. Insurance agents, brokers, and companies offering insurance policies that are not admitted or licensed in Louisiana must comply with this requirement.
3. The affidavit serves as a declaration of their eligibility and authorization to offer insurance coverage in the state as a non-admitted insurer.

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What is louisiana authorized non-admitted affidavit?

The Louisiana authorized non-admitted affidavit is a form filed by insurance companies to report non-admitted insurance policies.

Who is required to file louisiana authorized non-admitted affidavit?

Insurance companies operating in Louisiana are required to file the authorized non-admitted affidavit.

How to fill out louisiana authorized non-admitted affidavit?

The form can be filled out electronically or submitted via mail, and must include information such as the company's name, address, NAIC number, and details of non-admitted policies.

What is the purpose of louisiana authorized non-admitted affidavit?

The purpose of the Louisiana authorized non-admitted affidavit is to track non-admitted insurance policies and ensure compliance with state regulations.

What information must be reported on louisiana authorized non-admitted affidavit?

Information such as the company's name, address, NAIC number, details of non-admitted policies, and any other relevant information required by the state.