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Get Part C Affidavit
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How to fill out the Part C Affidavit online
The Part C Affidavit is a crucial document required for insurance processes in New York. This guide will walk you through the steps necessary to fill it out online, ensuring that you provide the correct information clearly.
Follow the steps to fill out the Part C Affidavit effectively.
- Click ‘Get Form’ button to obtain the Part C Affidavit form and open it in your online document editor.
- Enter the producing broker information, including your license number, name, address, city, state, and zip code.
- Input the risk information by providing the name of the insured. Ensure this name matches exactly with the declarations page or other official documentation.
- Complete the disclosure information section by selecting 'Yes' or 'No' to indicate whether you personally advised the insured about the possibility of coverage being written by unauthorized companies.
- Proceed to the declination information section. If the Superintendent has determined that declinations are not required for this type of risk, select 'Yes' for question (a) and skip to the affirmation section.
- If the answer to question (a) is 'No', answer question (b) regarding whether the risk was submitted to companies authorized in New York. If 'Yes', complete the additional details for each company that declined the risk.
- For each company declining the risk, provide the company name, NAIC code, date of declination, and the reason for decline. Specify your affiliation with the representative who declined the risk.
- Conclude with the affirmation section by confirming your identity and the accuracy of the information you provided. Sign and date the affidavit.
- After ensuring all sections are correctly filled out, save changes, and choose to download, print, or share the completed affidavit if necessary.
Complete your documents online confidently and accurately!
The process for a Part C Affidavit starts with drafting the document, including relevant facts and the affiant’s signature. Next, you must have it notarized to authenticate the signature. Finally, file the affidavit with the appropriate court or authority, ensuring you adhere to any specific state guidelines, which you can easily follow with US Legal Forms.
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