Disclosure Statement

Both forms contain similar wording but the D-1 form must be signed at the time the application is taken and dated and the D-2 form is attached to the policy once the policy is purchased.

The D-2 disclosure statement contains substantially the same wording as the D-1 disclosure statement but does not require a signature by the insured. Every policy issued by a surplus line insurer and every certificate evidencing the placement of insurance must contain or have affixed on the front by the insurer or surplus line broker, this disclosure statement in 16-point bold type.

The D-2 statement is required to renew a policy.

It is not necessary for a surplus line broker to file a copy of the D-2 statement with a policy submitted to the SLA.

Per CIC 1764.1 (a)(2), the applicant for insurance has the right to cancel the policy on a pro-rated basis return of premiums and return of broker fees paid for the placement of coverage.

Willful violation is a public offense. Any person who willfully violates Section 1760.5, 1761, 1763, 1764, 1764.1, 1764.2, 1764.3, 1764.4, 1765.1, 1765.2, 1767, or 1780 is guilty of a public offense and punishable by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or in a county jail for not exceeding one year or by fine not exceeding ten thousand dollars ($10,000), or by both.

No. It is not necessary to include the D-2 form with extension endorsements.