Get Declaration By Producer I Declare Under The Penalties ...

Filling out the Declaration by Producer form is crucial for ensuring compliance with Pennsylvania's insurance regulations. This guide provides a detailed, step-by-step approach to help you complete the form online accurately and efficiently.

Follow the steps to complete your declaration accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. Begin by entering your Customer ID number, Policy number, and Binder number as specified in the designated fields at the top of the form.
3. Indicate the type of filing by placing an 'X' in the appropriate box that corresponds to your situation: 1609-SLL/1609-PR, 1609-B, or 1610-A.
4. Provide information regarding the insured, including the Insured Name, Location of Risk, City, State, Zip, Kind of Insurance, Amount of Insurance, Class of Operations, Effective Date, and Expiration Date.
5. If applicable, check the box indicating if more than one carrier is being used. Enter the Key Carrier Number next to it.
6. Include the PA Portion Premium Charged in the specified field. If the insurance is tax exempt, check the box and complete the supplementary form, 1609/1610-SH.
7. Read and confirm that the insured has been notified in writing about the status of the insurer. You should mark the appropriate indication with an 'X' if applicable.
8. If needed, indicate if FORM 1606-A is attached by checking the corresponding box.
9. Fill in your Agency Name, Agency License Number, Individual Licensee details including Name and License Number.
10. Complete the form by signing in the space provided for the Signature of Licensee. Don’t forget to enter the date.
11. After checking all entries for accuracy, save changes, download, print, or share the completed form as necessary.

Start filing your declaration online today for a smoother insurance process.