Excess Line Placement Form PDF Details

If you are like most business owners, you know that accurate and timely invoicing is an important part of ensuring that your business runs smoothly. However, did you also know that there are specific formatting requirements for invoices? One such requirement is the placement of excess line form – or line spacing. In this post, we will explore what excess line form is and how to properly format it on your invoices. We will also provide some tips on how to make sure your invoices are as professional as possible. Let's get started!

QuestionAnswer
Form NameExcess Line Placement Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnotice of excess line placement form edit, 2011 nelp, notice excess line placement, directions to complete the ny notice of excess lines placement form

Form Preview Example

NOTICE OF EXCESS LINE PLACEMENT

Date:

Consistent with the requirements of the New York Insurance Law and Regulation 41

__________________________ is hereby advised that all or a portion of the required coverages have been

placed by __________________________________ with insurers not authorized to do an insurance business in

New York and which are not subject to supervision by this State. Placements with unauthorized insurers can only be made under one of the following circumstances:

a)A diligent effort was first made to place the required insurance with companies authorized in New York to write coverages of the kind requested; or

b)NO diligent effort was required because i) the coverage qualifies as an “Export List” risk, or ii) the insured qualifies as an “Exempt Commercial Purchaser.”

Policies issued by such unauthorized insurers may not be subject to all of the regulations of the Superintendent of Financial Services pertaining to policy forms. In the event of insolvency of the unauthorized insurers, losses will not be covered by any New York State security fund.

TOTAL COST FORM (NON TAX ALLOCATED PREMIUM TRANSACTION)

In consideration of your placing my insurance as described in the policy referenced below, I agree to pay the total cost below which includes all premiums, inspection charges(1) and a service fee that includes taxes,

stamping fees, and (if indicated) a fee(1) for compensation in addition to commissions received, and other expenses(1).

I further understand and agree that all fees, inspection charges and other expenses denoted by(1) are fully earned from the inception date of the policy and are non-refundable regardless of whether said policy is cancelled. Any policy changes which generate additional premium are subject to additional tax and stamping fee charges.

Re: Policy No.

Insurer

 

Policy Premium

 

$

Insurer Imposed Charges:

 

 

Policy Fees (1)

 

$

Inspection Fees (1)

 

$__________________

Total Taxable Charges

 

$

Service Fee Charges:

 

 

Excess Line Tax (3.60%)

 

$

Stamping Fee

 

$

Broker Fee (1)

 

$

Inspection Fee (1)

 

$

Other Expenses (specify) (1)_____________________________

$ ___________________

 

Total Policy Cost

$ ___________________

_____________________________________

(Signature of Insured)

(1)= Fully earned

NYSID FORM: NELP/2011