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Surplus Lines Affidavit

Surplus Lines Affidavit

 

INSTRUCTIONS: CONNECTICUT SURPLUS LINES AFFIDAVIT (Form SL-8)

 

 

To document Connecticut surplus lines, use a form SL-8. This document can be obtained from the website maintained by the government of Connecticut.

 

Connecticut Surplus Lines Affidavit SL-8 Step 1: Enter the name and address of the surplus lines broker on line 1.

 

Connecticut Surplus Lines Affidavit SL-8 Step 2: Enter the name of the producing agency on line 2.

 

Connecticut Surplus Lines Affidavit SL-8 Step 3: Enter the Connecticut license number of the producing agency on line 2a.

 

Connecticut Surplus Lines Affidavit SL-8 Step 4: Enter the agency represented on line 3.

 

Connecticut Surplus Lines Affidavit SL-8 Step 5: Enter the Connecticut license number of the agency represented on line 3a.

 

Connecticut Surplus Lines Affidavit SL-8 Step 6: Enter the name and location on the risk on line 4.

 

Connecticut Surplus Lines Affidavit SL-8 Step 7: Enter surplus lines insurers and their NAIC number on lines 5a and 5b.

 

Connecticut Surplus Lines Affidavit SL-8 Step 8: Enter the name of the associated representative on line 5c.

 

Connecticut Surplus Lines Affidavit SL-8 Step 9: Enter the kind of insurance on line 6.

 

Connecticut Surplus Lines Affidavit SL-8 Step 10: Enter the limits on line 6a.

 

Connecticut Surplus Lines Affidavit SL-8 Step 11: Enter the risk description on line 6b.

 

Connecticut Surplus Lines Affidavit SL-8 Step 12: Indicate whether this is a new business policy or renewal on line 7 with a check mark.

 

Connecticut Surplus Lines Affidavit SL-8 Step 13: Enter the reasons for placement on line 7b.

 

Connecticut Surplus Lines Affidavit SL-8 Step 14: Enter the premium on line 8.

 

Connecticut Surplus Lines Affidavit SL-8 Step 15: Indicate whether this is a term premium, installment or subject to audit with a check mark on line 8a.

 

Connecticut Surplus Lines Affidavit SL-8 Step 16: Enter the policy period on line 8b.

 

Connecticut Surplus Lines Affidavit SL-8 Step 17: On line 9, indicate with a check mark whether the broker completing this form has on file evidence of declination by three licensed insurers and ineligibility for any residential market mechanism.

 

Connecticut Surplus Lines Affidavit SL-8 Step 18: Enter the broker service fee on line 9a and the producer service fee on line 9b.

 

Connecticut Surplus Lines Affidavit SL-8 Step 19: The insured should sign the form in the presence of a notary public.

 

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