Managing General Agents - Excess/Surplus Wholesalers - Insurance Underwriters

New York Affidavit Forms

We use both admitted and non-admitted markets.  Your Proposal or Premium Indication will identify the insurer(s) and advice if admitted or non-admitted in each state.  Like most all jurisdictions, placements with NY eligible non-admitted insurers require special filings.  Filing forms  will accompany our proposal and terms.  If you require another copy you can access them here or on ELANY’s website at

If you have requested binding of NY business with a non-admitted insurer, your request to bind must include completed and signed:

Total Cost Form & Notice of Excess Lines Placement
Part C Affidavit by Producing Broker

irect questions about filing procedures to your Russell Bond Broker / Underwriter.

For complete details on NY procedures pertaining to Excess and Surplus Lines placements, refer to the Excess Lines Association of NY website at ELANY.

ELANY is charged with the duty to facilitate and encourage compliance with the NY excess line law.

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


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