Get Ohio Surplus Lines Affidavit

Filling out the Ohio Surplus Lines Affidavit online can streamline the process of acquiring necessary insurance coverage. This guide will provide you with step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to complete your affidavit online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part 1, which is the Statement of Surplus Line Broker or Originating Agent. Here, you will need to acknowledge your licensing status by confirming that you are a duly licensed full multiple line agent or surplus line broker. Complete your name and license details as required.
3. In this section, describe the property or risk to be insured clearly. Be specific to ensure accurate processing.
4. You must affirm that you have conducted due diligence as outlined in section 3905.33 of the Ohio Revised Code. This involves confirming that you have sought coverage from authorized insurers and listing any declinations received from these insurers in the provided space.
5. After completing Part 1, you will proceed to Part 2, which is the Affidavit of Insured. Here, the named insured will acknowledge their understanding that the policy will be with an unauthorized insurance company. Fill in the name of the insured and confirm their understanding of the implications.
6. The named insured must sign this section, including their name and title. This formalizes their consent to the arrangement.
7. A notary must witness the signing of the affidavit. Ensure that the notary fills in their signature and specifies their commission expiration date, which is crucial for the document’s validity.
8. Once all sections are completed and verified, you can save your changes, download the form, print a copy, or share it as needed.

Complete your Ohio Surplus Lines Affidavit online today and ensure that your insurance needs are met seamlessly.