# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 03 — Insurance Producers and Other Insurance Professionals

### Chapter 06 — Surplus Lines

#### Regulation .09 Disclosure Form.

*COMAR 31.03.06.09*

A. Printing Specifications; Provision of Form to Insured. The written disclosure required by Insurance Article, §3-308, Annotated Code of Maryland, shall be:

  (1) In the form set forth in §B of this regulation in at least 14-point type;

  (2) On a separate piece of paper that:

    (a) Contains only the disclosure; and

    (b) Is attached to the insurance contract or binder; and

  (3) Provided to the insured at the time of the initial purchase or delivery of an insurance contract or binder from a surplus lines insurer and at each renewal of the insurance contract.

B. Form.

C. In addition to the disclosure required by §B of this regulation, the surplus lines broker shall:

  (1) Provide a clear and conspicuous written disclosure to the prospective insured of:

    (a) Any inspection fee;

    (b) The total amount of the policy fee;

    (c) The premium tax on the policy;

    (d) Any financial interest of the person performing the inspection, if applicable;

    (e) Whether the surplus lines broker will receive compensation from the person that performs the inspection; and

    (f) Any charge for actual expenses incurred by the surplus lines broker for payment of the premium, policy fee, and any other fees and taxes relating to the policy by use of a credit card; and

  (2) Notify the prospective insured of the option to obtain the inspection from another person who meets the requirements of or is approved by the surplus lines broker.

D. Signature of Insured on Disclosure Form for Policies Covering Residential Property or a Condominium.

  (1) This section applies only to the written disclosure form for an insurance policy covering residential property or a condominium.

  (2) In addition to the text required by §B of this regulation, the disclosure form for an insurance policy covering residential property or a condominium shall include blanks for the insured's signature, the insured's printed name, and the execution date.

  (3) Whenever residential property or condominium insurance is placed or renewed with a surplus lines insurer, the originating insurance producer shall obtain the signature of the insured, the insured's printed name, and the execution date on the disclosure form.

  (4) On execution, the originating insurance producer shall:

    (a) Send the original copy of the disclosure form to the surplus lines broker;

    (b) Provide a copy of the disclosure form to the insured; and

    (c) Keep a copy of the disclosure form in the files of the originating insurance producer for at least 3 years after the date of execution by the insured.

  (5) The surplus lines broker shall:

    (a) Retain the original copy of the disclosure form for at least 3 years after the date of execution by the insured; and

    (b) Make the disclosure form available for inspection by the Commissioner on request.

E. Disclosure Form Requirements for Policies Not Covering Residential Property or a Condominium.

  (1) This section applies only to a written disclosure form for an insurance policy that does not cover residential property or a condominium.

  (2) The surplus lines broker or the originating insurance producer shall provide the insured with the written disclosure required by §B of this regulation in the manner specified by §A of this regulation.

  (3) The surplus lines broker or the originating insurance producer shall:

    (a) Certify on a form approved by the Commissioner that the disclosure notice required by this regulation has been delivered to the insured with the insurance policy or binder; or

    (b) Obtain from the insured written acknowledgment of receipt of the disclosure form.

  (4) If the surplus lines broker or the originating insurance producer obtains written acknowledgement of receipt of the disclosure form, the surplus lines broker or the originating insurance producer shall:

    (a) Retain for at least 3 years a copy of the written acknowledgment of receipt from the insured; and

    (b) Make the acknowledgment available for inspection by the Commissioner on request.