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How do I fill this out?
To fill out this form, start by entering your identifying information as a retail or producing agent. Next, provide details about the authorized insurers you contacted regarding coverage. Finally, document the reasons for any declinations received.
How to fill out the Statement of Diligent Effort for Insurance Coverage?
1
Enter your name, license number, and agency information.
2
List at least three authorized insurers that were contacted.
3
Provide contact details and the date of contact for each insurer.
4
Document the reasons for declination for each insurer.
5
Sign and date the statement to confirm the diligent efforts made.
Who needs the Statement of Diligent Effort for Insurance Coverage?
1
Insurance agents who need to document their diligent effort to obtain coverage.
2
Business owners seeking to secure surplus insurance but faced with declinations.
3
Insurance brokers who represent clients needing proof of efforts for compliance.
4
Surplus lines agents requiring documentation to validate rejection of coverage.
5
Regulatory bodies reviewing submissions from agents or agencies.
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1
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What are the instructions for submitting this form?
Submit this form via email to your compliance department or regulatory body. Ensure that you attach any required electronic declinations for each insurer contacted. For physical submissions, send it to the designated address provided on your agency’s website or regulatory guidelines.
What are the important dates for this form in 2024 and 2025?
Ensure that you are aware of submission deadlines for this form. It is crucial to keep track of regulations that may affect your requirements in 2024 and 2025. This ensures compliance and timely submissions for your insurance needs.
What is the purpose of this form?
The purpose of this form is to document the diligent efforts made by a retail or producing agent to obtain insurance coverage. It serves as a record of the attempts and rejections encountered from authorized insurers. This documentation is crucial for compliance with surplus lines regulations and helps in maintaining transparency in the insurance process.
Tell me about this form and its components and fields line-by-line.
- 1. Retail/Producing Agent Information: Captures details of the agent including name, license number, and agency.
- 2. Authorized Insurers Contacted: Section to list and document contacts made with authorized insurers.
- 3. Declinations: Requires documentation of reasons for declination from each contacted insurer.
- 4. Signature Section: Space for the agent's signature and date to validate the statement.
What happens if I fail to submit this form?
Failing to submit this form may result in non-compliance with insurance regulations.
- Inability to Access Coverage: Without this documentation, you may not be able to secure necessary insurance coverage.
- Regulatory Penalties: Non-compliance can lead to fines or other regulatory actions from governing bodies.
- Lack of Client Trust: Clients may question your diligence in securing coverage if documentation is absent.
How do I know when to use this form?
- 1. Documenting Insurance Efforts: To provide proof of the diligent effort made to obtain coverage from authorized insurers.
- 2. Regulatory Compliance: To comply with regulations that require documentation of coverage efforts.
- 3. Client Proposals: When presenting claims or proposals to clients needing assurance of your efforts.
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How many authorized insurers do I need to contact?
You need to contact at least three authorized insurers to fulfill the diligent effort requirement.
What should I do if an insurer declines my coverage?
Document the declination reason and proceed to contact the next authorized insurer.
Is there a specific format required for filling this form?
There is no strict format; simply ensure all required fields are completed accurately.
Do I need to print the form after filling it out?
You can download a digital copy, which may eliminate the need for printing.
What if I make a mistake while filling out the form?
You can easily edit any mistakes before finalizing and downloading your PDF.
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