Certificate of Effort

Nine Easy Steps For Completing the New Jersey Certificate of Effort


1. The 12 digit number known as the transaction number, or the affidavit number, is a unique number for each non admitted policy issued. The transaction number is formatted as follows: #####-##-##### The first five digits are the agency’s NJ Surplus Lines Number (issued to the agency by the DOBI), this number does not change. The next two numbers are the year in which the policy incepts. The last five digits are assigned by surplus lines agent and most often are just assigned sequentially.

2. Enter the full Named Insured

3. Enter the full Mailing Address

4. Enter the full risk location address

5. Enter the type of coverage afforded (i.e, commercial package, general liability, HO-3)

6. Enter full name of licensed retail agency

7. Enter full name of agent placing coverage (individual)

8. Enter the three declining admitted carriers. Full carrier name, the full name of the company employee who declined, the carrier’s phone number, the date of each declination. Must also include the applicable code/reason for declination as outlined on the affidavit. If declination was received via web based portal the NJDOBI suggests attaching a copy of the declination to the affidavit to remain in compliance. Current regulation wording does not take into account web based declinations. This extra step will demonstrate appropriate due diligence in the declination process.

9. Date and signed by the retail agent/originating producer.

Current New Jersey Certificate of Effort form

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complete list of exportable classes

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It is the responsibility of the retail and wholesale agents to maintain copies of the properly completed and signed affidavits for no less than five years.

A complete and signed Certificate of Effort is required on all non admitted policies. If there are multi policies issued for an insured than multiple affidavits and multiple SLA #s are required.

The only exception to this rule would be those classes of business deemed to be Exportable. Exportable class items require no affidavit.

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