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.

For Edit Submission

Date (for mapping FID-00)*

Date

For Business Lines*

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

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*

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)*

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

Full Name of Admitted Company (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

Full Name of Admitted Company (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

Signature*

Diligent Search (SL2 Form)