Get Ohio Surplus Lines Affidavit

Filling out the Ohio Surplus Lines Affidavit is an essential step for agents and insured individuals dealing with surplus line insurance. This guide will provide clear, step-by-step instructions to help you successfully complete the affidavit online.

Follow the steps to complete the affidavit efficiently.

1. Click ‘Get Form’ button to access the affidavit and open it in your chosen editor.
2. In Part 1, enter your name and title as the surplus line broker or originating agent. Ensure that you confirm your licensing status and that you have undertaken due diligence to procure the insurance policy required.
3. Provide details about the property or risk to be insured in the designated space.
4. List the authorized insurers you approached for the insurance policy in the provided section, along with the reasons for declination from each insurer.
5. Sign the affidavit as the surplus line broker or originating agent at the end of Part 1.
6. In Part 2, the named insured must enter their name and acknowledge that the insurance policy will be with an insurer not authorized in Ohio.
7. The insured person should understand and acknowledge that their insurer is not a member of the Ohio Insurance Guaranty Association by signing in their designated area.
8. A notary must witness the signed affidavit in Part 2. After filling out the notary section, ensure the document is signed and dated properly.
9. Review the completed affidavit for accuracy, then save your changes. You may download, print, or share the form as necessary.

Complete the Ohio Surplus Lines Affidavit online today for an efficient documentation process.