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Click ‘Get Form’ to open the island rhode document in the editor.
Begin by filling in your name and address as the Surplus Line Broker in the designated fields. Ensure accuracy to avoid any issues.
In the section regarding the date, enter the date you were engaged by the insured. This is crucial for record-keeping.
List all insurers that declined coverage in the provided spaces, including names of officers or producers who declined risk. This information is vital for compliance.
Proceed to complete the Affidavit by Insured section, where you will need to provide your name, address, and details about your insurance producer.
Finally, review all entries for accuracy before signing and dating the document at the bottom. Don’t forget to have it notarized as required.
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