February 23, 1981

SUBJECT: INSURANCE

Circular Letter No. 5 (1981)

WITHDRAWN

TO: ALL LICENSED EXCESS LINE BROKERS AND ALL PROPERTY AND CASUALTY INSURANCE COMPANIES

RE: FORMS REQUIRED BY REGULATION 41

Pursuant to Regulation 41, promulgated on November 25, 1980, attached are forms EL-1 and EL-2. Form EL-1 must be completed by the unauthorized insurer and form EL-2 by the Excess Line Broker. These forms should be reproduced as needed, but without any change. Form EL-1 will be required to be filed commencing with the end of calendar year 1981, and form EL-2 will be required to be used commencing March 1, 1981.

With reference to the affidavit required pursuant to Section 122 of the New York Insurance Law, please withhold the submission of said affidavits for policies with a 1981 effective date until a revised affidavit form is prescribed and sent to you.

Very truly yours,

[SIGNATURE]

Albert B. Lewis

Superintendent of Insurance

 

ATTACHMENT

Instructions

A separate column under "Names of Brokers" shall be used for each broker. This page should be reproduced as needed. Use as many pages as necessary to list all brokers your company does business with for property or risks located in the State of New York. The gross premium in each category is to be listed for each broker.

For alien insurers only, reporting on this form can be grouped into the five major groups as delineated below: 1-fire risks only; 2-all fire allied risks; 3-ocean marine risks; 4-all other property risks, and 5-all casualty risks. One figure next to the numbers 1 through 5 will be acceptable for alien insurers only.

When the New York broker or excess line broker is not known to the company filing this form, a list of insureds, arranged alphabetically with addresses, shall be permitted. This list shall indicate the gross premium for each insured.

Each company filing form EL-1 shall indicate the name and address of a person who may be contacted with reference to such form.

Contact Person: Name ______________________________

   Address ___________________________

   Telephone ________________________

(This form must be completed by the submitting broker or excess line broker and signed and dated by the company representative.)

I, ______________________ (Name), submitting broker or excess line broker, whose business address is __________________ (Street) _____________ (City) _______ (Zip) has submitted the risk hereinbelow described, to _____________________________________ (Name) _____________________________ (Address) an underwriter or agent having underwriting authority for the ____________________________ (Name of Company) a insurance company authorized to do an insurance business in the State of New York, hereby declares that on ______________, 19______, said risk was declined by the above-named underwriter or agent. The reason for declining said risk was: ____________________________________________ _________________________________________________________________

Name of Insured: _________________________________________________

Address of Insured: ___________________________Zip__________________

Type of Coverage Requested ______________________________________

_________________________________________________________________

_________________________________________________________________

(If more space is required attach additional sheets)__________________

Dated: ________________

Signed: __________________________________

submitting broker or excess line broker

I, the underwriter or agent having underwriting authority for the above-named company, confirm that the above information is correct.

Dated: ____________________

Signed: _______________________

underwriter or agent having underwriting authority

NOTE: INTENTIONALLY GIVING FALSE INFORMATION ON THIS FORM IS TANTAMOUNT TO COMMITTING PERJURY.