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Get DE SL-1925-A 2013

Rmerly Form SL-1916 THIS FORM IS TO BE FILED BY, OR ON BEHALF OF, INDIVIDUAL SURPLUS LINES BROKERS ONLY. AGENCIES CANNOT TRANSACT BUSINESS AND SHOULD NOT SUBMIT THIS FORM. SURPLUS LINES (SL) BROKER INFORMATION AND MAILING ADDRESS Individual SL Broker Name: Individual Broker ID #: (DE Lic. #) Agency Name: Individual Broker NPN: Agency Address: City State Zip + 4: Agency ID #: (DE Lic. #) Questions should be directed to: Tax Contact Name: Tax Contact E-mail: Ann Fletcher, Tax and F.

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