Document Resources

Since 1965 Gracechurch and our affiliated companies have been successfully working with brokers throughout the country. We have surplus lines licenses in Pennsylvania, New Jersey and New York, as well as an ability to write surplus lines business in other states. We can handle your specialty needs countrywide.

Please choose from the following:

• NJ Affidavit Form (DOC)
• Retailer NJ SL Statement (PDF)
• NY Affidavit Form – Part C – Producing Broker (DOC)
• NY Affidavit-Notice of Placement Form (DOC)
• PA Affidavit Form (ODT)