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SURPLUS LINES

Appendix 3 - Electronic Filing      Excel Workbook (30 KB)

*New version of Excel Workbook available (July 2008)—will create a formatted text file with a click of the “Create Text File” button.

The surplus lines licensee may file the annual surplus lines tax report electronically as permitted by rule or order of the Director. The surplus lines licensee shall thereafter maintain in the licensee's files the original verified annual surplus lines tax report in its entirety for a period ending five years after the filing of the verified annual surplus lines tax report. The electronic filing of the annual surplus lines tax report constitutes a representation by the licensee who files it that the licensee has in the licensee's possession at the time of electronic filing the fully executed original verified annual surplus lines tax report.

Step1:

• Create a semi-colon delimited text file containing your Appendix 3 report data.  See the Field Identification section below for information about what the file should contain.  NOTE:  Filenames must begin with the Surplus Lines licensee number and end with .txt for the file extension

Step 2:

• Submit the file to Insurance using one of the methods described below

Submission by e-mail:

• Send the semi-colon delimited text file to Surplus Lines (surpluslines@insurance.mo.gov) as an email attachment.
• In the body of the message identify the following:

  -	Appendix 3 Filing
  -	Surplus Lines licensee number and Surplus Lines broker name
  -	A contact person name, email address, and phone number

• Multiple filings may be submitted in the same email message

Submission by mail on diskette or CD:

• Label the diskette or CD with the following information

  -	Appendix 3 Filing
  -	Surplus Lines licensee number and Surplus Lines broker name
  -	A contact person name, email address, and phone number

• Multiple filings may be submitted on the same diskette or CD
• Make sure to scan the diskette or CD for viruses.
• Send to: Surplus Lines Section
  Missouri Department of Insurance, Financial Institutions & Professional Registration
  P. O. Box 690
  Jefferson City, MO 65102-0690

Field Identification:

• Filing Type:  For Appendix 3 filings, this will be 3.
• Risk Number:  The unique risk number assigned by the Missouri Department of Insurance, Financial Institutions & Professional Registration.
• Surplus Lines Licensee Number:  The 8-digit surplus lines licensee number preceeded with SL which is assigned by the Missouri Department of Insurance, Financial Institutions & Professional Registration. If you do not know the surplus lines licensee number, check the business entity producers listing.
• Coverage Type:  The 2-digit number for the coverage type assigned by the Missouri Department of Insurance, Financial Institutions & Professional Registration. Reveiw Insurance's website for the list of valid coverage types.
• Carrier Code:  The 3-digit number for each carrier assigned by the Missouri Department of Insurance, Financial Institutions & Professional Registration. Review Insurance's website for the list of valid carrier codes.
• Name of Insured: The complete name of the insured.
• Premium Amount Debit:  The dollar amount of the premium charged. If no amount, submit as 0 (zero). Do not use dollar signs, commas or double quotation marks!
• Premium Amount Credit:  The dollar amount of any premium reduction. If no amount, submit as 0 (zero). Do not include a negative sign. Do not use dollar signs, commas or double quotation marks!
• Tax Year:  The 4-digit tax year for the risk being reported.

Sample records (semi-colon delimited):

3;123456;SL123456;12;123;Name;999;999;2006;

3;123457;SL123457;12;345;Name;1000;0;2006;