Diligent Search Report Form Page 2
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1
2(B) If search was performed by someone other than the person named on line 1, please provide full name of that
individual:
___________________________________________________
7.
(A) Was the risk described in Section 2 submitted by you or by someone under your supervision to at least (3)
insurers that are admitted in California and who actually write the type of insurance described on lines 2(C) and
2(E)? (CHECK ONE)
YES
NO
(B) If YES, please complete ALL sections of the following table; if NO, skip to Section 8:
Full Name of Admitted Company
First & Last Name of Company
Check if
Month, Year
Declination
Representative AND Telephone
Employee (E)
of Declination
Code*
Number
or Agent (A)
1.
E
______________________________
(
)
-
/
A
or “Online Declination”
Website________________________
2.
E
______________________________
(
)
-
/
A
or “Online Declination”
Website________________________
3.
E
_______________________________
(
)
-
/
A
or “Online Declination”
Website________________________
*Declination Codes: 1 - Company's capacity reached
2-underwriting reason
3-refused to state
4-other
8.
If 7(A) was answered NO, complete the following:
(A) Did you determine that fewer than 3 admitted insurers actually write the type of insurance described on lines
2(C) and 2(E)? (CHECK ONE)
YES
NO
(B) If NO, please explain in detail why the risk was submitted to less than three admitted insurers in California that
write this type of insurance.
_______________________________________________________________________________________
___________________________________________________________________________________________
________________________________________________________________________________________
(C) If YES, please describe how you made this determination.________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
The undersigned licensee hereby certifies that this report is true and correct, and that this risk is not being placed with a non-
admitted insurer for the sole purpose of securing a rate or premium lower than the lowest rate or premium available from an
admitted insurer.
___________________________________________________________________
__________________
(Signature of Licensee Named on Line 1)
(Date)
SL-2 (Revised 06/2004)
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