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MAIL TO:Washington StateDepartment of Revenue PO Box 47464 Olympia WA 985047464January 201001Combined Excise Tax Return 10Filing an Amended Return? Check this box and attach a letter of explanation.NAME

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Gather all necessary information about the surplus line broker application.

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Insurance agencies or brokers who want to access the surplus line insurance market.

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What is 4 surplus line broker?

A 4 surplus line broker is a type of insurance broker that specializes in placing coverage with non-admitted insurers for hard-to-place risks.

Who is required to file 4 surplus line broker?

Insurance brokers who handle surplus line placements are required to file Form 4 with the appropriate regulatory authorities.

How to fill out 4 surplus line broker?

Form 4 must be filled out accurately and completely with all required information regarding the surplus line placements made by the broker.

What is the purpose of 4 surplus line broker?

The purpose of Form 4 is to track and monitor surplus line placements to ensure compliance with regulatory requirements.

What information must be reported on 4 surplus line broker?

Information such as the insured's name, policy details, premium amount, and surplus line insurer must be reported on Form 4.

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