Fill a Valid Delaware Sl Form

Fill a Valid Delaware Sl Form

The Delaware SL Form is a document required for surplus lines insurance in Delaware. This form must be signed by the licensed producing agent and submitted to the licensed surplus lines broker. It ensures compliance with state regulations and must be retained for examination by the commissioner for five years after coverage issuance.

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The Delaware Surplus Lines (SL) form is a crucial document in the realm of insurance, particularly for those navigating the complexities of obtaining coverage from non-licensed insurers. This form serves several key purposes, ensuring that both agents and brokers adhere to state regulations while providing necessary protections for insured parties. It must be signed by the licensed producing agent and forwarded to the licensed surplus lines broker, or alternatively, signed and retained by the surplus lines broker as part of their records. Importantly, the form must remain available for examination by the Commissioner for a period of five years following the issuance of the related coverage. The SL form requires detailed information, including the policy number, the name of the surplus lines insurer, and the insured's information, along with a declaration of diligent effort to secure coverage from licensed insurers. If such coverage cannot be obtained, the form outlines the reasons for seeking coverage from non-licensed companies, emphasizing that this step is not taken lightly. Additionally, it mandates that the insured is fully informed about the implications of choosing a non-licensed insurer, including the absence of protections typically offered by the Delaware Insurance Guaranty Association. Thus, the Delaware SL form plays a pivotal role in maintaining transparency and accountability within the insurance market, ensuring that all parties are aware of their rights and responsibilities.

Dos and Don'ts

When filling out the Delaware SL form, it is essential to follow certain guidelines to ensure accuracy and compliance. Here are nine important dos and don'ts:

  • Do ensure the form is signed by the licensed producing agent.
  • Do forward the completed form to the licensed surplus lines broker.
  • Do retain a copy of the form as part of the surplus lines broker records.
  • Do keep the form accessible for examination by the Commissioner for five years.
  • Do provide accurate information regarding the insured's name and mailing address.
  • Don't submit the form to the Insurance Department.
  • Don't fail to list the reasons for declining coverage from licensed insurers.
  • Don't neglect to explain to the insured that the insurance company is not authorized in Delaware.
  • Don't forget to include the required stamp on the insurance evidence provided to the insured.

Adhering to these guidelines is crucial for a smooth process and to avoid potential legal issues. Take the time to review the form carefully before submission.

Sample - Delaware Sl Form

THIS FORM MUST SIGNED BY THE LICENSED PRODUCING AGENT AND FORWARDED TO THE LICENSED SURPLUS LINES BROKER OR SIGNED AND RETAINED BY THE SL BROKER

RETAIN AS PART OF SURPLUS LINES BROKER RECORDS

THIS FORM MUST BE OPEN TO EXAMINATION BY THE COMMISSIONER AT ALL TIMES FOR 5 YEARS AFTER ISSUANCE OF THE COVERAGE TO WHICH IT RELATES. (18 DEL. C., §1915)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Submitted by: (select one)

 

 

 

 

DELAWARE INSURANCE DEPARTMENT

 

 

 

 

PRODUCER

 

 

 

 

 

 

 

SURPLUS LINES

 

 

 

 

SL BROKER

 

 

 

 

 

 

STATEMENT OF DILIGENT EFFORT

 

 

 

Form SL-1904

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

v.06-2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT SUBMIT THIS FORM TO THE INSURANCE DEPARTMENT

 

POLICY NUMBER

 

SURPLUS LINES INSURER NAME

 

 

 

 

NAIC #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURED'S NAME AND MAILING ADDRESS:

 

 

POLICY TERM INFORMATION

 

 

 

 

 

 

 

 

 

Name:

 

 

 

 

 

 

 

Effective Date

 

 

 

 

Expiration Date

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM/DD/YYYY Format

MM/DD/YYYY Format

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT OF INSURANCE

Property

$

 

 

Casualty

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION OF RISK

 

 

 

 

 

DESCRIPTION OF COVERAGE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I declare under the penalties provided by law that I have made a diligent effort to procure the insurance coverage described above from licensed insurers which are authorized to transact the class of insurance involved and which accept, in the usual course of business, insurance on risks of the same class as the risk described above. Having been unable to secure such coverage, I have resorted to coverage with companies not licensed to operate in the State of Delaware and which are not under the jurisdiction of the Insurance Department of the State of Delaware.

Furthermore, this insurance was not exported for the purpose of securing lower rates than would be accepted by an authorized insurer or because of the terms of the contract.

Among the licensed insurers declining to insure this risk or declining to increase the amount of insurance on this risk, are the following:

1.Name & NAIC # of Insurer: Name & Telephone # of Contact:

Reason for Declining:

2.Name & NAIC # of Insurer: Name & Telephone # of Contact: Reason for Declining:

3.Name & NAIC # of Insurer: Name & Telephone # of Contact: Reason for Declining:

I further attest that I have explained to the insured that the insurance described herein is being placed with an insurance company not authorized to do business in Delaware. The insured understands that the insurance company is not a member of the Delaware Insurance Guaranty Association and that Chapter 42 of the Delaware Insurance Code is not applicable to claimants or insureds of said company. As required in 18 Del. C., §1909, I have delivered to the insured evidence of the insurance upon which has been stamped:

This insurance contract is issued pursuant to the Delaware Insurance Laws by an insurer neither licensed by nor under the jurisdiction of the Delaware Insurance Department.”

I declare that I have the insurance coverage here described was procured pursuant to Chapter 19 of Title 18, the Delaware Insurance Code, and that the information contained in this submission is true.

Name of Producer/ SL

 

 

DE Lic # of

Agency

 

 

Agency

 

 

(Type or print name of Agency)

Name of Producer/ SL

 

 

DE Lic #

Broker

 

 

Individual

 

 

(Type or print name of Individual)

Producer/ SL Broker

 

 

 

Signature

Sign Here

 

Date:

Blank SL-1904-06

Direct any questions to: Ann.Fletcher@state.de.us

Similar forms

The Delaware Surplus Lines (SL) form shares similarities with the Non-Admitted Insurance Application, which is used in many states. Both documents require the applicant to demonstrate that they have made a diligent effort to secure coverage from licensed insurers. In the case of the Non-Admitted Insurance Application, the applicant must also provide a list of insurers who declined to provide coverage, similar to the requirements outlined in the Delaware SL form. This ensures transparency and accountability in the insurance procurement process.

Another document akin to the Delaware SL form is the Surplus Lines Declaration Form. This form is often used to declare that insurance coverage has been placed with a non-admitted insurer after exhausting all options with admitted carriers. Like the Delaware SL form, it requires detailed information about the risk, the coverage sought, and the reasons for resorting to a non-admitted insurer. Both forms aim to protect consumers by ensuring they understand the implications of using non-admitted insurance.

The Excess and Surplus Lines Insurance Application is also similar to the Delaware SL form. This application serves a similar purpose in documenting efforts made to secure coverage from licensed insurers. It requires the applicant to outline the reasons for seeking coverage from an excess and surplus lines carrier. Both documents emphasize the importance of due diligence in the insurance procurement process, aiming to ensure that applicants are making informed decisions.

The Certificate of Insurance for Surplus Lines is another document that parallels the Delaware SL form. This certificate provides evidence that insurance coverage has been obtained through a surplus lines broker. Similar to the Delaware SL form, it includes disclosures about the non-admitted status of the insurer and the lack of protection from state guaranty funds. This ensures that all parties involved are aware of the risks associated with non-admitted insurance.

The Application for Surplus Lines Coverage is yet another document that resembles the Delaware SL form. This application requires the producer to provide details about the risk and the efforts made to obtain coverage from licensed insurers. Both documents serve as a formal record of the diligence exercised in seeking coverage, reinforcing the importance of transparency in the insurance process.

The Surplus Lines Broker Affidavit is comparable to the Delaware SL form as well. This affidavit is a sworn statement by the surplus lines broker affirming that they have complied with all statutory requirements in placing coverage with a non-admitted insurer. Similar to the Delaware SL form, it aims to protect consumers by ensuring that brokers adhere to regulations while securing necessary insurance coverage.

The Notice to Insured for Non-Admitted Insurance is another document that aligns with the Delaware SL form. This notice informs the insured about the non-admitted status of their insurer and the potential risks involved. It is similar to the Delaware SL form in that it requires the broker to explain the implications of using a non-admitted insurer, ensuring that the insured is fully informed before proceeding with coverage.

Understanding the various forms related to insurance, such as the Delaware SL Form, is essential for both brokers and insureds to navigate the complexities of coverage. These documents ensure clarity and communication throughout the process, similar to the necessary documentation provided in child support cases. For those in Texas, securing the appropriate form is crucial, and you can find more information through All Texas Forms to assist in managing child support obligations effectively.

Finally, the Statement of Diligent Effort Form is closely related to the Delaware SL form. This statement outlines the efforts made to obtain coverage from licensed insurers and is often required in conjunction with surplus lines applications. Like the Delaware SL form, it emphasizes the necessity of documenting the due diligence performed in seeking insurance, ensuring that the process remains transparent and accountable.

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays or rejection of the form. Ensure that every section, including the policy number and insured's name, is complete and accurate.

  2. Incorrect Format: The dates must be entered in the specified MM/DD/YYYY format. Using an incorrect date format can result in processing errors.

  3. Neglecting Diligent Effort Documentation: Not providing a thorough list of licensed insurers that declined to cover the risk can undermine the validity of the submission. Each insurer’s name, contact information, and reason for declining should be clearly documented.

  4. Failure to Inform the Insured: It is crucial to explain to the insured that the coverage is being placed with an unlicensed insurer. Not doing so can lead to misunderstandings about the insurance's validity and the lack of protections under Delaware law.

  5. Signature Issues: The form must be signed by the licensed producing agent. If the signature is missing or incorrect, the submission will not be considered valid. Always double-check that the signature is present and matches the name printed on the form.

Documents used along the form

When dealing with the Delaware Surplus Lines (SL) form, several other documents and forms may be required to ensure compliance with state regulations. Each of these documents serves a specific purpose in the process of obtaining surplus lines insurance. Below is a list of commonly used forms that accompany the Delaware SL form.

  • Statement of Diligent Effort (Form SL-1904): This form is essential for documenting the efforts made by the producer to secure coverage from licensed insurers before resorting to surplus lines. It outlines the reasons for declining coverage from authorized insurers.
  • Surplus Lines Broker's Affidavit: This affidavit confirms that the surplus lines broker has fulfilled all necessary legal requirements and has acted in good faith while placing the insurance with an unauthorized insurer.
  • Insurance Policy Document: This is the actual policy issued by the surplus lines insurer. It contains the terms, conditions, and coverage details of the insurance being provided.
  • Proof of Coverage: A document provided to the insured that serves as evidence of the insurance coverage, including details about the insurer and the nature of the coverage.
  • Motor Vehicle Bill of Sale: A critical document in Texas, it records the sale of a vehicle, providing essential evidence and ensuring legal transfer of ownership. For more information, visit smarttemplates.net/fillable-texas-motor-vehicle-bill-of-sale.
  • Insurer's Financial Statement: A financial statement from the surplus lines insurer may be required to demonstrate the insurer's financial stability and ability to pay claims.
  • Consumer Disclosure Notice: This notice informs the insured about the nature of surplus lines insurance, including the lack of state protection and the absence of membership in the Delaware Insurance Guaranty Association.
  • Application for Surplus Lines Coverage: This application collects necessary information about the insured and the risk being covered, serving as a basis for the underwriting process.
  • Certificate of Authority: This document verifies that the surplus lines broker is authorized to operate in Delaware and can legally place insurance with non-licensed insurers.
  • Premium Tax Payment Receipt: A receipt confirming that the surplus lines premium tax has been paid to the state, which is a requirement for compliance.

Each of these documents plays a crucial role in the surplus lines insurance process, ensuring that all parties are informed and compliant with Delaware's insurance regulations. Proper management of these forms will help facilitate a smoother transaction and protect the interests of both the insured and the broker.

How to Use Delaware Sl

Completing the Delaware SL form requires careful attention to detail. This document must be signed by the licensed producing agent and forwarded to the licensed surplus lines broker. Alternatively, it can be signed and retained by the surplus lines broker as part of their records. The form must be available for examination by the Commissioner for five years after the issuance of the coverage it relates to.

  1. Begin by selecting the appropriate option under "Submitted by" to indicate whether the form is submitted by the Delaware Insurance Department, Producer, or Surplus Lines Broker.
  2. Fill in the "Policy Number" field with the specific policy number related to the insurance coverage.
  3. Enter the name of the "Surplus Lines Insurer" and its NAIC number in the designated fields.
  4. Provide the "Insured's Name" and their mailing address, ensuring accuracy in spelling and details.
  5. Complete the "Policy Term Information" section by entering the name, effective date, and expiration date of the policy in MM/DD/YYYY format.
  6. Specify the "Amount of Insurance" for both property and casualty in the respective fields.
  7. In the "Location of Risk" section, provide the address where the insured risk is located.
  8. Describe the coverage in the "Description of Coverage" section, ensuring clarity and completeness.
  9. List the licensed insurers that declined to provide coverage or increase the amount of insurance, including their names, NAIC numbers, contact names, phone numbers, and reasons for declining. Include up to three insurers.
  10. Attest that you have explained to the insured that the insurance is being placed with a company not authorized to operate in Delaware. Confirm that the insured understands the implications of this choice.
  11. Deliver evidence of the insurance to the insured, ensuring it is stamped with the required statement regarding the insurer's status.
  12. Sign the form, providing the name of the producer or surplus lines broker, along with the agency name and license number.
  13. Date the form appropriately.

After completing the form, ensure that all information is accurate and legible. Retain a copy for your records, as it may be required for future reference or compliance checks.

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