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Get DE SL-1923 (Formerly SL-1904) 2006

S FORM MUST SIGNED BY THE LICENSED PRODUCING AGENT AND FORWARDED TO THE LICENSED SURPLUS LINES BROKER OR SIGNED AND RETAINED BY THE SL BROKER Submitted by: (select one) Blank SL-1904-06 DELAWARE INSURANCE DEPARTMENT SURPLUS LINES PRODUCER STATEMENT OF DILIGENT EFFORT Form SL-1904 SL BROKER v.06-2 DO NOT SUBMIT THIS FORM TO THE INSURANCE DEPARTMENT SURPLUS LINES INSURER NAME POLICY NUMBER INSURED'S NAME AND MAILING ADDRESS: NAIC # POLICY TERM INFORMATION Name: Effective Date Expirat.

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