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Declaration (surplus lines business)

As a condition of transacting insurance business in the United States, the NAIC generally requires that individuals must provide an NAIC Biographical Affidavit. However, Lloyd’s has agreed with the NAIC that where individuals make the following declaration it is no longer necessary the NAIC Biographical Affidavit to be submitted. Lloyd’s therefore requires that all individuals appointed to one of the following positions must provide a declaration in the terms set out here. Individuals required to make the declaration include anyone appointed to be:

  1. A director of a managing agent or member’s agent
  2. An active underwriter
  3. A director or partner of an approved run-off company
  4. A run-off manager of an approved run-off company
  5. (If the appointment being notified is not to one of the above positions, the NAIC declaration does not apply)

If you are not the individual giving the declaration, then by clicking on the "Accept" button you are taken to be confirming that you have shown the declaration to the individual making the declaration (the "Applicant") and that you have their authority to confirm the following on their behalf. In all instances it is recommended that a record is kept evidencing that the individual making the declaration has seen it and, as appropriate, has agreed to it being made on his behalf. 


I, the Applicant, understand, acknowledge, agree and confirm:

  1. that references to my PRA or FCA Application to Perform Controlled Functions under the Approved Persons Regime (PRA Rulebook Reference SUP 10B or FCA Handbook Reference SUP 10A) (the “Application”) include any subsequent correspondence, data or information submitted by me to the PRA or FCA to supplement or amend the Application; and
  2. that, at the request of Lloyd’s, I will provide forthwith to Lloyd’s a copy of the Application and that all or part of the Rich-Text-contents of the Application, and any copies thereof, whether in electronic form or otherwise, may be transmitted between Lloyd’s and the International Insurers Department of the National Association of Insurance Commissioners in the United States; and
  3. that all or part of the Rich-Text-contents of the Application, and any copies thereof, may be submitted on my behalf, whether in electronic form or otherwise, to insurance regulatory officials in any of the fifty states of the United States, the District of Columbia or any of the territories of the United States as a condition and specifically for the purpose of enabling me to transact insurance business in the United States and its jurisdictions; and
  4. that governmental regulatory officials in the United States and its jurisdictions will rely on the completeness and accuracy of the information contained in the Application and on my representation of its completeness and accuracy; and
  5. that if misleading information is contained in the Application , including by omission, I may be subject to criminal and civil penalties in the United States under the law of the United States and/or any of its states, territories or jurisdictions, including possible imprisonment for a period of up to fifteen (15) years; and
  6. that I have thoroughly read the information provided in the Application and that it is complete and accurate to the best of my knowledge and belief; and
  7. to submit to the regulatory and disciplinary jurisdiction of Lloyd’s and be bound by and to comply with the provisions of Lloyd’s Acts 1871-1982, the rules, byelaws and requirements made thereunder and any condition or penalty imposed or requirement made thereunder and every direction or code of practice made by or under the authority of the Council under Lloyd’s Acts 1871-1982.