SL2 Form P-Lines (v 101)

Note: You do not need to enter the information from scratch to create a completed SL2. You can either bridge the information from the Home quote form or from the Homeowners CPA to save time. However, if we do not have a prior completed quote form or CPA then enter the information in the following fields in order to get a completed SL2 pdf copy. After submission check your inbox for completed copy.

Purpose: The SL2 is only required for policies that are underwritten on a Non-Admitted Basis. This can be indentified and determined by the writing company on the policy. FYI, policies written on an Admitted Basis is never going to require an SL2.

Date (for mapping FID-00)*

Date

For Edit Submission

Transaction Type*

For Business Lines*

Stop: This form is only used for Personal Lines, You can select Commercial Lines SL2 if needed.

Master Company*

Writing Company*

Producer & Agency Info:

Full Name of Agency/Organization*

Enter exactly as it appears on the agency license

Person completing form (LSI)*

The completed PDF form will be emailed to the email address associated with this person

Agency/Organization DOI License Number*

DOI issued license # of Agency/Organization

Full Name of Individual Producer (LSI)*

Must be Name of licensed producer/Acc. Manager

Full Name of Individual Producer*

Producer DOI License Number*

DOI issued license # of producer/Acc. Manager

Applicant/Location Info:

First & Last Name (1st App) *

Name of Insured

Physical Location of Home (map it) *

	Address
Street
City
State
Zip

Address Type*

Physical Street

Physical City

Physical State

Physical Zip

Address (map it) *

	Address
Street
City
State
Zip

Mailing Street

Mailing City

Mailing State

Mailing Zip

Description of Risk (Not type of Coverage)*

Type of Insurance Coverage*

Admitted Carrier Info:

Full Name of Admitted Company (1st)*

NAIC Number (1st)

1. Month of Declination (Only Enter a Number)*

Example: if February enter 2, if March enter 3

1. Year of Declination (Only Enter a Number)*

Example: 2019, 2020

Carrier Website for Declination (1st)

Full Name of Admitted Company (2nd)*

NAIC Number (2nd)

2. Month of Declination (Only Enter a Number)*

Example: if February enter 2, if March enter 3

2. Year of Declination (Only Enter a Number) 2nd*

Example: 2019, 2020

Carrier Website for Declination (2nd)

Full Name of Admitted Company (3rd)*

NAIC Number (3rd)

3. Month of Declination (Only Enter a Number)*

Example: if February enter 2, if March enter 3

3. Year of Declination (Only Enter a Number) 3rd*

Example: 2019, 2020

Carrier Website for Declination (3rd)

Question 4 - Type of Insurance

Diligent Search (SL2 Form)