Managing General Agents - Excess/Surplus Wholesalers - Insurance Underwriters

New York Affidavit Forms

We use both admitted and non-admitted insurers. Your Quote or Premium Indication will identify the insurer(s) and advise the status of each in the state. Placements with eligible non-admitted insurers in NY require special filings like most all jurisdictions. The forms should accompany our terms, but if they didn't or were damaged / misplaced, you can access them here.

If you have requested binding of NY business with a non-admitted insurer(s) here is a copy of the (1) NOTICE OF EXCESS LINE PLACEMENT / TOTAL COST FORM and (2) PART C - AFFIDAVIT BY PRODUCING BROKER.

The forms should reach us within 10 days of the effective date (but absolutely no more than 30) for filing with ELANY within the mandatory 45 day period. Any questions about filing procedures can be directed to Sarah Torgler at Ext. 284 or email at or speak to your Broker / Underwriter.

For complete details on NY procedures pertaining to Excess / Surplus Lines placements go to
ELANY . The New York State Legislature created the Excess Line Association of New York (ELANY) to help facilitate and encourage compliance with NY statutes and regulations. They are a great resource.

Click here for the Total Cost Form and New York Affidavit Part C.


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