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Get Acknowledgement Proforma

SURPLUS LINES DISCLOSURE and ACKNOWLEDGEMENT At my direction name of insurance agency has placed my coverage in the surplus lines market. As required by Florida Statute 626. 916 I have agreed to this placement. I understand that superior coverage may be available in the admitted market and at a lesser cost and that persons insured by surplus lines carriers are not protected by the Florida Insurance Guaranty Association with respect to any right of recovery for the obligation of an insolvent unlicensed insurer. I further understand the policy forms conditions premiums and deductibles used by surplus lines insurers may be different from those found in policies used in the admitted market. I have been advised to carefully read the entire policy. Named Insured By Signature of Named Insured Printed Name and Title of Person Signing Name of Excess and Surplus Lines Carrier Type of Insurance Effective Date of Coverage Date. As required by Florida Statute 626. 916 I have agreed to this placement. I understand that superior coverage may be available in the admitted market and at a lesser cost and that persons insured by surplus lines carriers are not protected by the Florida Insurance Guaranty Association with respect to any right of recovery for the obligation of an insolvent unlicensed insurer. I further understand the policy forms conditions premiums and deductibles used by surplus lines insurers may be different from those found in policies used in the admitted market. I further understand the policy forms conditions premiums and deductibles used by surplus lines insurers may be different from those found in policies used in the admitted market. I have been advised to carefully read the entire policy. Named Insured By Signature of Named Insured Printed Name and Title of Person Signing Name of Excess and Surplus Lines Carrier Type of Insurance Effective Date of Coverage Date. As required by Florida Statute 626. 916 I have agreed to this placement. I understand that superior coverage may be available in the admitted market and at a lesser cost and that persons insured by surplus lines carriers are not protected by the Florida Insurance Guaranty Association with respect to any right of recovery for the obligation of an insolvent unlicensed insurer. I further understand the policy forms conditions premiums and deductibles used by surplus lines insurers may be different from those found in policies used in the admitted market. I have been advised to carefully read the entire policy. Named Insured By Signature of Named Insured Printed Name and Title of Person Signing Name of Excess and Surplus Lines Carrier Type of Insurance Effective Date of Coverage Date.

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Keywords relevant to Acknowledgement Proforma

  • unlicensed
  • Acknowledgement
  • premiums
  • disclosure
  • Statute
  • placement
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