Get Surplus Lines Disclosure Form

Filling out the Surplus Lines Disclosure Form is an essential step in understanding your insurance coverage. This guide provides clear, step-by-step instructions to help you complete the form online efficiently.

Follow the steps to successfully complete the Surplus Lines Disclosure Form

1. Click the ‘Get Form’ button to access the Surplus Lines Disclosure Form. This will allow you to open the document in your preferred online editor.
2. Begin by entering the name of the insured in the 'Named Insured' field. Ensure that the names match any official documentation related to the insurance coverage.
3. In the 'Signature of Insured’s Authorized Representative' section, the individual authorized to sign on behalf of the insured should provide their signature. This may require an electronic signature if filling out the form online.
4. Next, complete the 'Name of Excess and Surplus Lines Carrier' field by entering the name of the insurance provider, which in this case is 'Certain Underwriters at Lloyds, London.'
5. Indicate the type of insurance being covered in the 'Type of Insurance' field. For example, you may write 'General Liability' if that is applicable.
6. Fill in the 'Effective Date of Coverage' by inputting the date when the coverage begins. This typically reflects when the policy is initiated.
7. Finally, include the current date in the designated 'Date' section to affirm that you are submitting the form on this specific date.
8. Once all fields are completed, you may save changes, download the document for your records, print it for physical filing, or share it with relevant parties as needed.

Complete your Surplus Lines Disclosure Form online today to ensure your insurance coverage is properly documented.