Get Acknowledgement Proforma

Filling out the Acknowledgement Proforma accurately is essential for ensuring compliance with relevant Florida statutes. This guide offers a clear pathway through each section of the form, empowering users to complete it with confidence.

Follow the steps to fill out the Acknowledgement Proforma correctly.

1. Click the ‘Get Form’ button to obtain the Acknowledgement Proforma and open it in your preferred online editor.
2. Begin by entering the name of the insurance agency in the designated field. This identifies who placed the coverage in the surplus lines market.
3. In the next section, provide your agreement to the placement by including your signature as the named insured. This step acknowledges your consent as required by Florida Statute 626.916.
4. Below your signature, print your name and title. This ensures that your identity and authority are clearly documented.
5. Specify the name of the excess and surplus lines carrier in the corresponding field. This identifies the insurer responsible for your coverage.
6. Indicate the type of insurance you are obtaining. This information helps clarify the nature of the coverage.
7. Insert the effective date of coverage. This is crucial for determining when your policy becomes active.
8. Finally, enter the date of completion at the bottom of the form to confirm when this document was finalized.
9. After filling out all required fields, ensure you review your information for accuracy. You can then save changes, download, print, or share the completed form as needed.

Take the next step in managing your insurance: complete the Acknowledgement Proforma online today!