Nysid form 41c: Fill out & sign online

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Click ‘Get Form’ to open the NYSID Form 41C in the editor.
Begin by filling out the Producing Broker Information section. Enter your License Number, Name, Address, City, State, and Zip Code accurately.
In the Risk Information section, provide the Name of the Insured. Ensure it matches exactly with other documents like declarations pages or binders.
Proceed to the Disclosure Information section. Select 'Yes' or 'No' based on whether you advised the insured about coverage being written by unauthorized companies.
For Declination Information, answer question (a) regarding whether declinations are required. If 'Yes', skip to the Affirmation section; if 'No', continue with questions (b) and (c).
If applicable, complete the schedule for Authorized Companies Declining the Risk by listing each company’s name, NAIC code, date of declination, and reasons for decline.
Finally, in the Affirmation section, sign and date the form to confirm that all information is accurate to your knowledge.

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Upload your nysid form 41c to DocHub (once you’ve created an account for this). If you need to complete fields in it, use proper tools from the top pane. For instance, drop Signature Fields, assign each to a particular party, and click on Sign → Request signatures from others. Personalize your message for your recipients and click Send Request. You can also send your document by fax or as a Signing link instead of using email (you’ll locate these options by navigating to the Menu → Send)

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