Part C Affidavit - Fill and Sign Printable Template Online 2026

1. Click ‘Get Form’ to open the Part C Affidavit in our editor.
2. Begin by filling in the Producing Broker Information section. Enter your License Number, Name, Address, City, State, and Zip Code accurately.
3. Proceed to the Risk Information section. Ensure that the Name of the Insured matches exactly with the declarations page or any related documents.
4. In the Disclosure Information section, select 'Yes' or 'No' regarding whether you provided a written Notice of Excess Line Placement as required.
5. For Declination Information, answer questions (a), (b), and (c) as applicable. If you answer 'Yes' to question (a), skip to the Affirmation section.
6. If necessary, complete the Authorized Companies Declining the Risk sections by providing details for each company that declined coverage.
7. Finally, in the Affirmation section, sign and date the affidavit to confirm that all information is true to your knowledge.

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