2021-2025 Form

Understanding the INS4024 Surplus Lines Statement

The INS4024 Surplus Lines Statement is a crucial document used in the insurance industry in the United States. It serves as a declaration of surplus lines insurance, which is coverage obtained from non-admitted insurers. These insurers are not licensed in the state where the insurance is being sold, making this statement essential for regulatory compliance. The statement provides transparency regarding the placement of insurance and ensures that the appropriate taxes and fees are collected by state authorities.

How to Complete the INS4024 Surplus Lines Statement

Filling out the INS4024 Surplus Lines Statement requires careful attention to detail. Begin by gathering all necessary information about the insured, the coverage being placed, and the non-admitted insurer. The form typically includes sections for the name and address of the insured, details about the insurance policy, and the premium amount. It is important to accurately report this information to avoid any compliance issues. Once completed, the statement should be reviewed for accuracy before submission.

Key Elements of the INS4024 Surplus Lines Statement

Several key elements must be included in the INS4024 Surplus Lines Statement to ensure it meets regulatory standards. These elements include:

• Name and address of the insured: This identifies the individual or entity purchasing the insurance.
• Details of the insurance coverage: This includes the type of coverage and the policy number.
• Non-admitted insurer information: The name and address of the insurer providing the coverage.
• Premium amount: The total cost of the insurance being purchased.
• Signature of the producer: The licensed agent who facilitated the insurance placement must sign the statement.

Filing Deadlines for the INS4024 Surplus Lines Statement

Timely filing of the INS4024 Surplus Lines Statement is essential to avoid penalties. Each state may have specific deadlines for submission, often aligned with the end of the insurance policy period. It is advisable to check with the relevant state insurance department for the exact dates. Generally, the statement should be filed within a certain number of days after the policy is issued to ensure compliance with state regulations.

Legal Considerations for the INS4024 Surplus Lines Statement

The INS4024 Surplus Lines Statement must be completed in accordance with state laws governing surplus lines insurance. Each state has its own regulations regarding the use of non-admitted insurers, and failure to comply can result in significant penalties. It is important for agents and brokers to stay informed about these regulations to ensure that they are operating within the legal framework. Additionally, proper documentation and record-keeping are essential for any audits or reviews conducted by state authorities.

Obtaining the INS4024 Surplus Lines Statement

The INS4024 Surplus Lines Statement can typically be obtained through state insurance departments or industry associations. Many states provide downloadable versions of the form on their official websites. Additionally, insurance brokers and agents may have access to the form through their professional networks. It is important to ensure that the most current version of the form is used, as regulations and requirements may change over time.