The Delaware SL form is a crucial document used in the surplus lines insurance process. It serves as a declaration that the licensed producing agent has made diligent efforts to secure coverage from authorized insurers but was unable to do so. This form must be signed and retained by the surplus lines broker, ensuring compliance with Delaware insurance regulations.
The Delaware SL form, specifically known as the Statement of Diligent Effort (Form SL-1904), plays a crucial role in the surplus lines insurance process within the state. This form must be completed and signed by a licensed producing agent before being forwarded to a licensed surplus lines broker. Alternatively, the surplus lines broker may sign and retain the form as part of their records. It is essential that this documentation remains accessible for examination by the Commissioner for a period of five years following the issuance of the related coverage. The form requires detailed information, including the policy number, the name of the surplus lines insurer, and the insured's information, along with specific coverage details. Producers must declare their diligent efforts to obtain coverage from licensed insurers before resorting to non-licensed options. This declaration includes listing any licensed insurers that declined to provide coverage, along with their reasons for doing so. Additionally, it emphasizes the importance of informing the insured about the implications of securing coverage from a non-licensed insurer, including the lack of protection from the Delaware Insurance Guaranty Association. By adhering to these requirements, producers ensure compliance with Delaware's insurance laws and maintain transparency with clients.
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
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
(Type or print name of Agency)
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
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