OH INS4024 2021-2025 free printable template

Surplus Lines Statement Mike DeWine, Governor Judith L. French, Director Jon Hosted, Lt GovernorOPRAS Division (PC), 50 W Town Street, 3rd Floor Suite 300, Columbus OH 43215 16146442635 | Fax 16147281280

How to fill out ohio surplus lines statement

How to fill out ins4024 surplus lines statement

1. Obtain the INS4024 Surplus Lines Statement form from the appropriate regulatory agency.
2. Fill out the form with the required information, including the name of the insured, policy number, policy effective dates, and premium amounts.
3. Provide any additional documentation or information that may be required, such as details on the type of coverage provided or the nature of the insured's business.
4. Double check the information provided for accuracy and completeness before submitting the form to the regulatory agency.

Who needs ins4024 surplus lines statement?

1. Insurance agents and brokers who are selling surplus lines insurance.
2. Insurance companies that are providing surplus lines coverage.
3. Regulatory agencies that oversee the surplus lines insurance market.

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What is ins4024 surplus lines statement?

The ins4024 surplus lines statement is a document that reports surplus lines insurance transactions conducted by a surplus lines broker, detailing the policies placed with non-admitted insurers.

Who is required to file ins4024 surplus lines statement?

Surplus lines brokers who place policies with non-admitted insurers are required to file the ins4024 surplus lines statement.

How to fill out ins4024 surplus lines statement?

To fill out the ins4024 surplus lines statement, brokers must provide details like the name of the insured, the policy number, the coverage period, and the premium amount, along with the insurer information.

What is the purpose of ins4024 surplus lines statement?

The purpose of the ins4024 surplus lines statement is to ensure regulatory oversight and compliance of surplus lines transactions, providing transparency regarding the placement of insurance with non-admitted insurers.

What information must be reported on ins4024 surplus lines statement?

The information that must be reported includes the name and address of the insured, policy number, type of coverage, policy period, total premium, and details about the non-admitted insurer.