New York Affidavit - Quaker Special Risk Insurance 2026

1. Click ‘Get Form’ to open the New York Affidavit - Quaker Special Risk Insurance in the editor.
2. Begin by filling out the Producing Broker Information section. Enter your License Number, Name, Address, City, State, and Zip Code accurately.
3. In the Risk Information section, provide the Name of the Insured. Ensure it matches exactly with other documents like the declarations page.
4. For Disclosure Information, indicate whether you provided a written Notice of Excess Line Placement to the insured by selecting 'Yes' or 'No'.
5. Proceed to Declination Information. Answer questions (a), (b), and (c) as applicable. If any answer is 'Yes', follow instructions to skip subsequent questions as directed.
6. Complete the Authorized Companies Declining the Risk section for each company that declined coverage. Include their name, NAIC code, date of declination, and reasons for decline.
7. Finally, in the Affirmation section, sign and date the affidavit confirming all information is true to your knowledge.

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