Get the free surplus lines disclosure form

Has placed my coverage in the surplus lines market. As required by Florida Statute 626.916, I have agreed to this placement. I understand that superior coverage ...

How to fill out surplus lines disclosure form

How to fill out a surplus lines disclosure form:

1. Start by gathering all the necessary information and documentation required for the form. This may include details about the insured, the insurance policy, and the type of coverage being provided.
2. Fill in the relevant sections of the form accurately and completely. Provide the required information about the insured, such as their name, address, contact details, and any other pertinent details.
3. Clearly state the details of the insurance policy being offered, including the coverage limits, effective dates, and any specific terms or conditions.
4. Include any additional information or disclosures required by the relevant regulatory authorities or jurisdictions. This may involve disclosing any potential risks, limitations, or exclusions associated with the insurance policy.
5. Double-check all the information provided on the form to ensure accuracy and completeness. Make sure there are no errors or omissions that could potentially lead to complications or legal issues.
6. Once you are satisfied with the completeness and accuracy of the form, sign and date it accordingly. This signifies that the information provided is true and correct to the best of your knowledge.
7. Keep a copy of the filled-out form for your records and submit the original form to the appropriate recipient or regulatory body. Ensure that you are aware of any specific submission requirements or deadlines.
8. If necessary, follow up with the recipient or regulatory body to confirm the receipt of the form and address any potential issues or concerns they may have.

Who needs a surplus lines disclosure form:

1. Insurers or insurance agents involved in providing surplus lines insurance coverage.
2. Policyholders or insured individuals seeking coverage from non-admitted insurers or for specific types of risks not readily available in the standard insurance market.
3. Regulatory authorities or jurisdictional bodies requiring the disclosure of surplus lines insurance details for monitoring, compliance, or consumer protection purposes.

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What is surplus lines disclosure form?

A surplus lines disclosure form is a document that provides information about insurance coverage obtained from non-admitted insurers, indicating that the insurance was placed outside the standard market, typically to cover risks that cannot be insured through admitted insurance carriers.

Who is required to file surplus lines disclosure form?

Insurance brokers or agents who place coverage with non-admitted insurers are required to file the surplus lines disclosure form, ensuring compliance with state regulations regarding surplus lines insurance.

How to fill out surplus lines disclosure form?

To fill out a surplus lines disclosure form, the broker must provide details about the insured, the risk being covered, the non-admitted insurer, and the terms of coverage, including premiums and limits. It's essential to ensure all required fields are completed accurately.

What is the purpose of surplus lines disclosure form?

The purpose of the surplus lines disclosure form is to document the placement of insurance with non-admitted insurers and to provide transparency and protection for consumers, as well as to ensure compliance with state surplus lines regulations.

What information must be reported on surplus lines disclosure form?

The information that must be reported on a surplus lines disclosure form typically includes the name of the insured, details of the insurance coverage, the name and address of the non-admitted insurer, the premium amount, and any relevant underwriting information or disclosures.