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Surplus Lines Disclosure and Acknowledgement
At my direction, name of insurance agency has placed my coverage in the surplus lines market. As required by Florida Statute 626.916, I have agreed to
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How to fill out surplus lines disclosure and
How to fill out surplus lines disclosure and
01
Step 1: Obtain the surplus lines disclosure form from the appropriate regulatory authority.
02
Step 2: Fill in the necessary information, such as the name of the insured, policy number, and effective date of the policy.
03
Step 3: Provide details about the surplus lines broker or agent involved in the transaction.
04
Step 4: Disclose the total premium amount and applicable taxes and fees.
05
Step 5: Include any additional required information, such as the insurer's name and address.
06
Step 6: Review the completed form for accuracy and completeness.
07
Step 7: Sign and date the surplus lines disclosure form.
08
Step 8: Submit the completed form to the relevant parties, such as the insured, surplus lines broker, and regulatory authority.
Who needs surplus lines disclosure and?
01
Insurance companies or brokers dealing with surplus lines insurance policies.
02
Policyholders who are purchasing insurance coverage from non-admitted insurers or out-of-state insurers.
03
Surplus lines brokers who are responsible for placing insurance with non-admitted insurers.
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What is surplus lines disclosure and?
Surplus lines disclosure is a form that provides information on insurance policies obtained from non-admitted insurers.
Who is required to file surplus lines disclosure and?
Insurance agents and brokers are required to file surplus lines disclosure.
How to fill out surplus lines disclosure and?
Surplus lines disclosure can be filled out electronically or manually by providing details about the non-admitted insurance policies.
What is the purpose of surplus lines disclosure and?
The purpose of surplus lines disclosure is to track non-admitted insurance coverage and ensure compliance with state regulations.
What information must be reported on surplus lines disclosure and?
Information such as the policyholder's name, policy number, coverage amount, premium paid, and details of the non-admitted insurer must be reported on surplus lines disclosure.
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