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FSLSO Home » Publications and Info » FSLSO Forms

Forms

• Quarterly Report Affidavit
  Note: Surplus Lines Agents may file quarterly affidavit information via the Surplus Lines Information Portal in lieu of mailing a notarized paper form.
• Diligent Effort/Surplus Lines Disclosure Matrix
• Surplus Lines Disclosure
• Diligent Effort Form
• Catastrophe Information Form
• Sample Face/Front Page
• Transfer of Business
Agent Refund Request Forms
• FSLSO Service Fee Refund Request Form
• FL DFS Tax Refund Request Form
• Citizens Assessment Refund Request Form
• DEM EMPA Surcharge Refund Request Form
• FHCF Refund Request Form

Independently Procured Coverage
• IPC Refund Request Forms
• Per Florida Statute 626.938, all Florida IPC Information must be filed via the FSLSO IPC web portal.

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DISCLAIMER: The information provided should not be interpreted or used as a legal opinion, nor does it supersede directives provided by state or other governing authorities. The Florida Surplus Lines Service Office does not provide legal or tax advice. Whenever agents, brokers, companies, or policyholders have specific questions pertaining to business practices, tax implications or statutory interpretation, we urge the respective parties to seek the counsel of a competent attorney or tax consultant licensed in the appropriate jurisdiction and area of expertise.

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