Surplus Lines Brokers Premium Report Forms
For policies effective prior to 7/21/2011:
- Reporting Instructions for Surplus Lines Brokers
- Monthly Premium Report Summary
- Multi-State Allocation Form
- Statement of Exempt Premiums
- Report of Surplus Lines Transaction
- Annual Premium Tax Report 2011 pdf | excel
- Unauthorized Insurer's Tax Form (rev. 11/09)
For policies effective on or after 7/21/2011:
UPDATE: All policies where the home state is Alaska, the tax will be calculated on 100% of the policy premium at Alaska's tax rate of 2.7% and filing fee of 1% regardless of whether the policy is multi-state or not.- New Reporting Instructions
- New Quarterly Report
- Report of Surplus Lines Transaction
- Statement of Exempt Premiums
- Unauthorized Insurer's Tax Form (rev. 8/11)
Useful Links
- Eligible Surplus Lines Insurers
- Line Codes for Surplus Lines Transaction Reports
- Broker Fees and the Appointment of Insurance Producers as Brokers
- Order R11-04 - Surplus Lines Placement List
- Surplus Lines Placement List
- Stamping Requirements
- Premium Tax Audits – Surplus Lines Brokers (Coming Soon)
- Affidavit of Due Diligence (UPDATED)
- Quarterly Listing of Alien Insurers
