When you are looking to buy a new home, it is important to do your due diligence. This means investigating all of your options and making sure that you are getting the best deal possible. One way to do this is by using a due diligence form. A due diligence form can help you track of all the important information related to buying a home. It can also help you stay organized and on top of things during the buying process. There are many different types of due diligence forms, so it is important to find one that fits your needs. The form should include information about the property, such as its address, price, and square footage; as well as your own personal information, such as your credit score and budget. Be sure to update the form regularly as you gather more information about the property. A due diligence form can be an invaluable tool when buying a home. It will help you stay organized and make sure that you don't miss any important details. Use it wisely and ensure a smooth
| Question | Answer |
|---|---|
| Form Name | Due Diligence Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | west virginia due diligence form, west virginia department of insurance surplus lines due diligence form, wv due diligence form, blank due diligence form |
Offices of the West Virginia Insurance Commissioner
Due Diligence Form (Form DDF – Revised 8/09)
New
Renewal
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Customer ID #
This form must be forwarded to the licensed surplus lines licensee placing the risk in the surplus lines market and must be retained in his or her office and may be examined at any time by the commissioner pursuant to W.Va. C.S. R.
1.
hereby submits that he/she is a duly licensed individual insurance producer under West
Producer Name (Type or Print)
Virginia Offices of the Insurance Commissioner license number
2.Risk Description
(A)Insured Name
Type or Print
(B)Address of Insured
Street and Number, City, State, Zip
(C)Description of Risk
e.g. Laundromat, Liquor Store. (Do Not List Type of Coverage)
(D)Location of Risk
Street and Number, City, State, Zip
(E)Type of Coverage
3.Is the type of coverage described on lines 2(C) and 2(E) on the current West Virginia
Export List for both the type of insurance and the location in the State? |
YES |
NO
If you answered NO, continue to Number 4 below.
4.I declare under penalty of perjury, that I have made a diligent search to procure the insurance coverage described above for licensed insurers in West Virginia which are authorized to transact the kind of insurance involved and which provide, in the course of business, coverage comparable to the coverage being sought. I have contacted the insurers that I represent customarily writing the find of insurance requested by the insured and have been unable to procure said insurance. The licensed insurers declining to insure this risk are as follows:
Full Name of Admitted Company
NAIC # Name of Company Representative and Telephone Number
Date of
Declination
Declination
Code*
*Declination Codes: 1=Company’s Capacity Reached; 2=Underwriting Reason; 3=Refused to State; 4=Other
If Other was used as a Declination Code, explain below:
NOTICE TO INSURED
I,
, have been expressly advised prior to the placement of the insurance that:
Insured (Print or Type)
1)The surplus lines insurer with which the insurance is placed is not an admitted authorized insurer in this State and is not subject to the Insurance Commissioner’s supervision; and
2)In the event the surplus lines insurer becomes insolvent, claims will not be paid nor will unearned premiums be returned by any West Virginia guaranty fund.
Signature of Insured
Date
The undersigned licensed individual insurance producer who performed or supervised the diligent search hereby certifies that this report is true and correct, and that this risk is not being placed with a
Licensed Individual Insurance Producer (Print or Type) |
Signature of Licensed Individual Insurance Producer |
Date |