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INSTRUCTIONS FOR EXCESS LINE BROKER APPLICANTMatch the submission code numbers listed under the Resident (one who has declared New York as their Home State; Home State means the District of Columbia

How to fill out excess line supplemental statement

How to fill out excess line supplemental statement

1. To fill out the excess line supplemental statement, follow these steps:
2. - Start by providing your name and contact information at the top of the form.
3. - Indicate the policy number and effective date of the excess line insurance policy.
4. - Describe the nature of the risk or exposure that the excess line coverage is intended to address.
5. - Provide details about the primary insurance policy, including the insurer's name, coverage limits, and any specific terms or conditions.
6. - Explain the reasons why the risk cannot be insured through the standard market and why excess line coverage is necessary.
7. - Provide any additional relevant information that may help underwriters assess the risk.
8. - Review the completed form for accuracy and make any necessary corrections before submitting it.

Who needs excess line supplemental statement?

1. Excess line supplemental statement is typically required by individuals or businesses seeking insurance coverage for high-risk or unconventional risks that cannot be covered by standard insurance policies available in the market.
2. It is commonly used by insurance brokers, agents, or underwriters when securing excess line coverage for their clients.
3. These clients may include individuals or businesses involved in industries such as construction, manufacturing, entertainment, professional services, or any other high-risk enterprises.

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What is excess line supplemental statement?

Excess line supplemental statement is a report filed by insurers to provide additional information on excess line insurance policies that are not recorded in the standard insurance statements.

Who is required to file excess line supplemental statement?

Insurance companies or insurers who underwrite excess line insurance policies are required to file excess line supplemental statements.

How to fill out excess line supplemental statement?

Excess line supplemental statements can be filled out electronically through designated regulatory platforms or submitted via mail following the provided guidelines and required information.

What is the purpose of excess line supplemental statement?

The purpose of excess line supplemental statement is to ensure proper reporting of excess line insurance policies and to provide regulators with additional information for monitoring and oversight.

What information must be reported on excess line supplemental statement?

Information such as policy details, premium amounts, insured parties, coverage limits, and other relevant data related to excess line insurance policies must be reported on the excess line supplemental statement.