Surplus lines forms by state

Evidence of Compliance

Affidavit of Due Diligence 08-1236

Policy Holder Notice

Order R22-01 Surplus Lines Placement List

Order R25-02 Surplus Lines Placement List

Generic Diligent Effort Form

Generic Diligent Effort Form

Disclosure to Surplus Line Insured Form SL-3

Coverage Codes

D-1 Disclosure

D-2 Notice

California Commerial Insured / Exempt Commercial Purchaser Sample Checklist (1/1/2025)

SL-2 (2024) Instructions

Confidential Report of Surplus Line Placement (SL-1 Form)

Diligent Search Report (SL-2 Form, 2024 Version)

California surplus lines brokers document their diligent search efforts to place coverage with admitted insurers, listing insurers contacted, declinations received, and the specific risk details and coverage type involved.

Diligent Search Report (SL-2 Form, Pre-2024)

Diligent Search Report (SL-2 Form) Addendum

Statement of Diligent Effort (4/15/2025)

Surplus lines brokers document rejections from three authorized insurers to demonstrate diligent effort requirement for placing coverage in the surplus lines market.

Connecticut Export List

Insured Acknowledgement & Diligent Effort

Connecticut surplus lines compliance form documenting insured acknowledgment and broker's diligent effort to place coverage with admitted carriers before binding excess insurance.

Statement of Diligent Effort Form SL-1923

Exempt Commercial Purchaser Application SL-1914

Surplus Lines Broker Notice to Insured SL-1917

Generic Diligent Effort Form

Statement of Diligent Effort

Surplus Lines Disclosure and Acknowledgement

FSLSO Diligent Effort / Disclosure Matrix

Application for a Consumer's Certificate of Exemption DR-5 Form

NCUA Tax Exemption Letter

Sample Face Page

Generic Diligent Effort Form

Disclosure Brochure

Diligent Search Statement

Generic Diligent Search Statement

Producer/Broker Fee Disclosure Form

Sample Affidavit of Diligent Search

Exempt Commercial Purchaser 41-1213

Diligent Search Statement

Generic Diligent Effort Form

Surplus Lines Diligent Search Form

Regulatory documentation for Iowa surplus lines producers certifying diligent search of admitted insurers and attestation of compliance before placing non-admitted coverage.

Statement of Insured

Diligent Search Form

Generic Diligent Effort Form

Acknowledgement of Applicant 22:438 Form (12/27/2018)

Generic Diligent Effort Form

Diligent Search Statement

Surplus Lines Disclosure

Affidavit by Assured BR-7 Form

Affidavit by Assured

Generic Diligent Effort Form

Export List

Generic Diligent Effort Form

Informational Notice Form

Generic Diligent Effort Form

Generic Diligent Effort Form

Submission and Disclosure Form

Diligent Search Statement

Declination Detail

Diligent Search Statement

SL Insured Acknowledgment

Certification of Effort

Exhibit A-2

Producing Broker Affidavit

Part A - Affidavit By Excess Line Broker

Affidavit - Part C

New York excess line placements: certifies broker compliance with declination requirements, Notice of Excess Line Placement delivery, and documents insurers that declined the risk.

Affidavit - Part C

Export List

NY Disclosure Credit Insurance for IVF or IUI

NY Parametric Disclosure

Notice of Excess Line Placement & Total Cost Form

Notice of Excess Line Placement & Total Cost Form

Generic Diligent Effort Form

Form F - Risk Purchasing Group

Surplus Lines Affidavit (4818)

Surplus Lines Statement

Diligent Search Statement

Diligent Search Statement - Form 100

NCUA Tax Exemption Letter

Wet Marine Tax Reporting Form

Electronic Signature Addendum 1609-SLL

Declaration by Producer 1609-PR Form

Diligent Search Statement

Affidavit - Exhibit A

Diligent Search Statement

Diligent Search Statement

Diligent Search Form

Tennessee surplus lines and IPC filing requirement: documents declinations from admitted carriers before placing coverage with non-admitted insurers.

Diligent Effort Form

Complaint Notice

Exempt Commercial Purchaser (ECP) Form

Non-Texas Premium/Exempt Premium Allocation Form

Required Disclosure for Occupational Policies

Diligent Search Affidavit

Evidence of Good Faith Effort to Place

Documents surplus lines producers' good faith efforts to place coverage with admitted insurers before accessing surplus lines market, listing contacted insurers and declination reasons.

ECP Affidavit

Diligent Search Statement

Virginia Form SLB-9

Generic Diligent Effort Form

Compensation Disclosure Form

Consumer Notice

Due Diligence Form DDF (8/2024)

Statement of Diligent Effort

Notice of Surplus Lines Placement