Agents

In North Carolina, any resident licensed P&C insurance agent may place surplus lines business through any licensed resident or nonresident surplus lines licensee. Any licensed P&C agent may sign the "Form F" as "Producing Broker". The surplus lines insurer must be on the approved "White List". Be sure your surplus lines broker or "surplus lines licensee" is properly licensed. Effective October 1, 2001 all nonresidents writing surplus lines risks located in North Carolina must be licensed.

Download Form F is the newly revised Form F to be used in North Carolina. This form must be completed and retained by the surplus lines licensee that is responsible for filing the taxes on the related transaction. Effective April 1st, 2001, the North Carolina Department of Insurance no longer required certain language on the Form F to be in an contrasting color ink. They do require that certain text be in "bold" print. This form meets this new requirement. You may download this form to your computer or open it online. Once open, you may click in the first yellow box and type in the appropriate text. Use your "Tab" key to move between fields. When you complete the form, you may save the completed form or print it on your local printer. If you save the completed form, you may attach it to an email and send it to your insured to print and sign.

Form F

Click here to download the Form F. Instructions are provided on this page as well.