Get Montana Surplus Lines Submission Form - Montana - State Auditor ... - Csi Mt

This guide provides a comprehensive overview of how to effectively fill out the Montana Surplus Lines Submission Form. By following these steps, users can ensure accurate and complete submissions to the Montana State Auditor's office.

Follow the steps to complete your submission form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the policy number as issued by the insurance company. Do not include any agency information.
3. Provide the insured's name and the Montana street address, city, and zip code for the risk location in the designated areas.
4. Indicate whether this is filed on a binder by selecting ‘Yes’ or ‘No’.
5. In Part 1, affidavit of the producing insurance producer section, enter the state and county where the agent is located at the time of signing. Include the original signature of the producing producer.
6. Check ‘Yes’ or ‘No’ to indicate if the risk is on the most recent Approved Risk List (ARL). If it is, provide the specific number.
7. If the risk is not on the ARL, describe the type of risk and explain why coverage is unavailable from authorized insurers.
8. Indicate the prior insurer's name if any, and explain why they did not renew the coverage. Provide a renewal quote if available, entering ‘None’ if there is none.
9. If you are filing under the 10% and $1,500 exception, check ‘Yes’ or ‘No’.
10. Provide the financial stability rating and the rating date for the unauthorized insurer.
11. List a minimum of three authorized insurers contacted as part of your diligent efforts, including the quotes received.
12. Sign the form, include the date, and enter your Montana license number.
13. In Part 2, enter the surplus lines producer's name, agency name, and address, as well as the original signature and Montana license number.
14. In Part 3, complete the premium, tax, and fee information sections by entering the name of the unauthorized insurer, policy period, and premiums.
15. Calculate and enter the premium tax and stamping fee based on the policy premium.
16. Final steps include signing the document, and submitting the original along with a self-addressed stamped envelope to the Montana Commissioner of Securities and Insurance.

Complete your Montana Surplus Lines Submission Form online today to ensure timely processing.