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Get Arkansas Sl 3 Form

Finally Affiant states that the information contained in the Disclosure to surplus Line Insured a copy of which is attached hereto was made known to the Insured prior to the procuring of the coverage in a nonadmitted insurer and that the insured s signature thereon was obtained as soon as reasonably possible. Originating Agent or Broker Agency Represented Address Telephone Number Subscribed and sworn to or affirmed before me This day of 19. Notar.

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