Get Part C Affidavit By Producing Broker - Decotis Insurance

Filling out the PART C affidavit by producing broker from DeCotis Insurance can be straightforward when you have clear guidance. This document is crucial for ensuring compliance with insurance laws, and this guide will help you navigate each section effectively and confidently.

Follow the steps to complete the affidavit efficiently.

1. Press the ‘Get Form’ button to access the document and open it in your preferred editing tool.
2. In the first section, provide the producing broker information, including the affidavit number, license number, name, address, city, state, and zip code.
3. In the risk information section, enter the name of the insured exactly as it appears on the declarations page or confirmation of coverage.
4. For the disclosure information, indicate whether you provided a written Notice of Excess Line Placement to the insured by selecting 'Yes' or 'No'.
5. In the declination information section, answer the questions regarding whether the Superintendent has determined that declinations are not required. If yes, skip to the affirmation section.
6. If the answer to declination questions is 'No,' provide details as instructed and complete the schedule for each company that declined the risk, including the company's name and the reasons for declination.
7. Complete the affirmation section by signing and dating it, confirming all information provided is true to the best of your knowledge.
8. Once you have filled in all necessary information, review the document for accuracy and completeness.
9. Finally, you can save your changes, download, print, or share the completed form as needed.

Complete your documents online confidently and efficiently.