Get the free Surplus Lines Disclosure Form - FAIA

Surplus Lines Disclosure Form This form is designed to provide guidance only based on the statutory requirements for such form, and it has not been approved by the Florida Department of Financial

How to fill out surplus lines disclosure form

How to fill out a surplus lines disclosure form:

1. Begin by accessing the surplus lines disclosure form. This form can typically be found on the website of the insurance regulatory authority in your state.
2. Carefully read through the instructions and guidelines provided with the form. Familiarize yourself with the specific requirements and any necessary supporting documentation.
3. Start by filling out the basic information section of the form. This typically includes details such as the insured's name, address, contact information, and policy number.
4. Proceed to the section that requires disclosure of the surplus lines broker or agent involved in the transaction. Provide their name, license number, and contact details.
5. Complete the section that requests information about the insurer. This involves providing the name of the surplus lines insurer, their NAIC number, and the type of insurance coverage being obtained.
6. If applicable, fill out the section related to the sponsoring insurer or the stamping office. This information may not be required in all states, so make sure to check if it is necessary for your specific situation.
7. Next, provide details about the insured risk. This can include information about the insured property, the nature of the risk being insured, and any other relevant details.
8. Review the completed form to ensure all information is accurate and complete. Double-check for any errors or omissions that may affect the validity of the form.
9. In some cases, the form may require a signature from the insured or their authorized representative. Follow the instructions provided to properly sign and date the form.
10. Make copies of the completed form for your records and any parties involved in the transaction, such as the surplus lines broker or agent and the insured.

Who needs a surplus lines disclosure form:

1. Any individual, business, or organization that is seeking to obtain insurance coverage from a surplus lines insurer may need to complete a surplus lines disclosure form.
2. Insurance producers or brokers who are facilitating the placement of surplus lines insurance policies are also likely to be involved in the completion of this form.
3. It is important to note that the requirement for a surplus lines disclosure form may vary from state to state. Some states may have specific rules or thresholds that determine when this form is necessary. Therefore, it is always advisable to consult your state's insurance regulatory authority or seek professional advice to determine if a surplus lines disclosure form is required for your specific situation.

For pdfFiller’s FAQs

What is surplus lines disclosure form?

Surplus lines disclosure form is a form that is used to report information about insurance policies that are placed with non-admitted insurers.

Who is required to file surplus lines disclosure form?

Insurance brokers and agents are required to file surplus lines disclosure form.

How to fill out surplus lines disclosure form?

To fill out surplus lines disclosure form, one must provide information about the non-admitted insurer, insured party, policy details, and other relevant information.

What is the purpose of surplus lines disclosure form?

The purpose of surplus lines disclosure form is to ensure that information about non-admitted insurance policies is reported accurately and in a timely manner.

What information must be reported on surplus lines disclosure form?

Information such as the name of the non-admitted insurer, policy number, coverage details, premium amount, and insured party details must be reported on surplus lines disclosure form.

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