Get the free Surplus Lines Statement

This document serves as a declaration for surplus line brokers or originating agents, affirming their inability to procure certain insurance policies from authorized insurers in Ohio and includes

How to fill out surplus lines statement

How to fill out surplus lines statement

1. Start with the basic information: Include your name, address, and contact details.
2. Identify the insured: Provide the name and details of the individual or business seeking insurance.
3. Describe the insurance coverage: Clearly explain the type of insurance coverage being requested.
4. List the surplus lines insurer: Include the name of the non-admitted insurer providing coverage.
5. State the reason for surplus lines: Indicate why a surplus lines insurer is required (e.g., unavailability of coverage from admitted carriers).
6. Provide financial information: Detail any relevant financial data or underwriting information required by the state.
7. Review and sign: Check all entries for accuracy, then sign and date the statement to certify its correctness.

Who needs surplus lines statement?

1. Businesses or individuals who seek insurance coverage that is not available from admitted insurers.
2. Insurance brokers who are working on behalf of clients to procure necessary coverage.
3. Companies operating in high-risk industries that may require specialized insurance solutions.

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What is surplus lines statement?

A surplus lines statement is a document that provides information about an insurance policy that is written by a non-admitted insurer. It is used to disclose these types of policies to the appropriate regulatory authorities.

Who is required to file surplus lines statement?

Typically, licensed surplus lines brokers are required to file a surplus lines statement. They are responsible for ensuring that the statement is submitted to the regulatory authority in their state.

How to fill out surplus lines statement?

To fill out a surplus lines statement, brokers need to provide details such as the policyholder's information, the insurer's name, policy number, coverage amounts, and any applicable premium amounts. The form usually requires signing and dating by the broker.

What is the purpose of surplus lines statement?

The purpose of a surplus lines statement is to ensure transparency and compliance with state insurance regulations. It allows regulators to maintain oversight over the writing of insurance policies by non-admitted insurers.

What information must be reported on surplus lines statement?

The information that must be reported on a surplus lines statement generally includes the name and address of the insured, the name of the surplus lines insurer, policy details, coverage limits, and the premium amount, along with any endorsements associated with the policy.