Get the free Surplus Lines Disclosure and Acknowledgement form

SURPLUS LINES DISCLOSURE and ACKNOWLEDGEMENT At my direction, has placed my coverage in the surplus lines market. As required by Florida Statute 626.916, I have agreed to this placement. I understand

How to fill out surplus lines disclosure and

How to fill out surplus lines disclosure and:

1. Obtain the necessary surplus lines disclosure form from your insurance provider.
2. Fill in the policyholder's name, address, and contact information accurately.
3. Provide details about the insurance policy, including the coverage period, limits, and any additional endorsements.
4. Disclose the premium amount paid for the surplus lines coverage.
5. Complete the section on the insured risks, describing the specific exposures and liabilities being covered.
6. Sign and date the surplus lines disclosure form, ensuring that all the information provided is true and accurate.
7. Submit the completed form to your insurance provider or relevant regulatory authority, as required.

Who needs surplus lines disclosure and:

1. Businesses or individuals seeking insurance coverage from a surplus lines carrier.
2. Insurance brokers or agents who are placing coverage with a surplus lines carrier on behalf of their clients.
3. Regulatory authorities or state insurance boards that require surplus lines disclosure in order to monitor and regulate the surplus lines market.

People Also Ask about

What is surplus lines insurance Florida?

Surplus lines insurance is coverage for specific risks that the standard or admitted market is either unable or unwilling to cover. While the admitted market is where most consumers find coverage, the surplus lines market is vital as a supplement for those consumers and businesses that cannot find coverage otherwise.

What is Florida surplus lines policy for insurance for?

Surplus lines insurance is coverage for specific risks that the standard or admitted market is either unable or unwilling to cover. While the admitted market is where most consumers find coverage, the surplus lines market is vital as a supplement for those consumers and businesses that cannot find coverage otherwise.

What does surplus lines mean in insurance?

Surplus lines insurance protects against a financial risk that a regular insurance company will not take on. Surplus lines insurance policies are available in a variety of types for both individuals and businesses. Surplus lines insurance is generally more expensive than regular insurance because the risks are higher.

What is a d1 surplus lines form?

A: The D-1 statement contains wording specified by statute that notifies the applicant that the insurance he or she is applying to purchase is with an insurer not licensed by the state of California.

What is the purpose of a surplus lines broker?

A surplus lines broker is an insurance intermediary who represents the insured rather than the insurer. A surplus lines broker specializes in helping consumers find surplus lines insurance coverage in the non-admitted market.

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What is surplus lines disclosure?

Surplus lines disclosure is a document that provides information regarding insurance policies placed with non-admitted insurers, which are not licensed to operate in a specific state.

Who is required to file surplus lines disclosure?

Surplus lines brokers or agents who arrange insurance coverage with non-admitted insurers are required to file surplus lines disclosure with the appropriate regulatory authority.

How to fill out surplus lines disclosure?

To fill out a surplus lines disclosure, brokers must provide details about the insured, the insurer, the coverage terms, and the reason for obtaining insurance from a non-admitted carrier, among other required information.

What is the purpose of surplus lines disclosure?

The purpose of surplus lines disclosure is to ensure transparency and regulation in the placement of insurance with non-admitted insurers, protecting consumers and allowing regulators to monitor the surplus lines market.

What information must be reported on surplus lines disclosure?

The information that must be reported on surplus lines disclosure includes the name of the insured, the name of the non-admitted insurer, the type of coverage provided, the policy limits, and the premium amount, along with a description of the risk.