Get the free Surplus Lines Statement - Ohio Department of Insurance - insurance ohio

Product Regulation Property & Casualty 50 W. Town St. Suite 300 Columbus, OH 43215 (614) 644-2635 Fax (614) 728-1280 www.insurance.ohio.gov Ohio Department of Insurance John R. Kasich Governor Mary

How to fill out surplus lines statement

How to fill out surplus lines statement:

1. Obtain the necessary form: Contact your state's insurance department or visit their website to obtain the surplus lines statement form specific to your jurisdiction.
2. Fill in the basic information: Provide your name, contact information, and the name of your insurance agency or brokerage.
3. Identify the insured: Provide the name and contact information of the insured party for whom the surplus lines coverage is being obtained.
4. Provide policy details: Include the policy number, effective dates, and coverage limits for the surplus lines policy.
5. State the premiums: Clearly indicate the amount of premium being charged for the surplus lines coverage.
6. Disclose the surplus lines broker: If you are a licensed surplus lines broker, provide your name, contact information, and license number.
7. Sign and date the statement: Ensure that all necessary signatures are obtained and the statement is dated.
8. Submit the statement: Follow the instructions provided by your state's insurance department to properly submit the completed surplus lines statement.

Who needs surplus lines statement:

1. Insurance brokers or agents: Individuals who have the authority to place surplus lines coverage on behalf of insureds.
2. Insured parties seeking non-traditional coverage: Businesses or individuals who require insurance coverage that is not readily available from standard insurance markets.
3. Insurance companies: Surplus lines statements may be required by insurance companies to properly document the placement of coverage and comply with regulatory requirements.

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What is surplus lines statement?

Surplus lines statement is a report filed by insurance companies in some states to disclose policies that were obtained from a non-admitted insurance company.

Who is required to file surplus lines statement?

Insurance companies who engage in surplus lines insurance transactions are required to file surplus lines statement.

How to fill out surplus lines statement?

Surplus lines statement can typically be filled out electronically through the regulatory agency's designated online portal.

What is the purpose of surplus lines statement?

The purpose of surplus lines statement is to provide transparency and ensure compliance with state regulations regarding non-admitted insurance transactions.

What information must be reported on surplus lines statement?

Information such as policy details, premiums, commissions, and taxes related to non-admitted insurance policies must be reported on surplus lines statement.