The Surplus Line Association of Utah
6711 South 1300 East Salt Lake City, Utah 84121
Phone 801-944-0114 or Fax 801-944-0116

The following statement of premium, written by non-admitted insurers is hereby offered for filing, pursuant to the provisions of the Utah Insurance Code and applicable rules of the Utah Insurance Department.

Please use the following link to download the Evidence of Good Faith form, which you will then need to print out and mail in with your submission form. Thank you.

*Note: If you have chosen to complete your submission electronically, this form is included in the electronic submission process.

Download the Evidence of Good Faith form (61kb) Right-click and choose 'Save Target As...'