Surplus Lines Affidavit

# STATE OF ALASKA ## DEPARTMENT OF COMMERCE & ECONOMIC DEVELOPMENT DIVISION OF INSURANCE STEVE COWPER, GOVERNOR P. O. BOX D JUNEAU, ALASKA 99811-0800 PHONE: (907) 465-2515 ### BULLETIN NO. 89-3 TO: ALL SURPLUS LINES/BROKERS, RESIDENT AND NON-RESIDENT, LICENSED IN THE STATE OF ALASKA RE: FILING SURPLUS LINES AFFIDAVITS The Division of Insurance hereby withdraws Bulletin 86-3 and replaces it with Bulletin 89-3. Bulletin 89-3 will enable effective enforcement of the Surplus Lines Law without undue burden on the reporting surplus lines brokers. This bulletin reflects these changes. To reduce the burden of filing in a manner consistent with retaining, in the Division of Insurance, adequate information to assure compliance with all laws and regulations, the following procedures are established: 1. AS 21.34.080 will be satisfied by the filing of Revised Form 205A, on a monthly basis for each nonadmitted carrier. This form shall be backed up by an attached bordereaux of surplus lines placements showing the name of the insured, policy number, name of each vessel, rate of tax, filing fee, and the amount of premium charged. FAILURE TO DO SO IS IN VIOLATION OF AS 21.34.080. 2. This form and supporting bordereaux shall be filed monthly, no later than thirty days after the last day of each calendar month. This bulletin shall be effective with respect to each of the above requirements. Done this 1st day of June, 1989. Paul Roller PR/DD/dgl4319D 052689a 08-H11LH