Appendix 3 Electronic Filing   

Section 384.057 RSMo requires that before March 2, of each year each Surplus Lines Producer shall file with the Director the Surplus Lines tax report know as the Appendix 3 form. If you held a Surplus Lines license anytime during the tax year, you are required to submit the Appendix 3 form. If no business was placed, you are required to file a zero return.

General information Excel Workbook (68 KB)
(xlsm for macros )

To save this excel workbook, click on the link and "Open." If a Windows Security window displays, click "Cancel."

• The surplus lines licensee is mandated to file the annual surplus lines tax report electronically as permitted by rule or order of the Director. This report must be filed even if zero business.
  
• 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.

Step 1

• Using the provided Excel spreadsheet template, submit your Appendix 3 report data. The Excel Workbook will create a formatted text file with a click of the “Create Text File” button. You can attach the Excel file or text file. We will convert Excel files into text for you if you prefer.
• See the section below for information about what the file should contain.

Field identification

Field headings are on the Excel file only. When the Excel file is converted to a text file the headings are eliminated.

• Filing type: For Appendix 3 filings, this will be 3. This will automatically populate when the SL# is entered into the appropriate column.
• Risk number: The unique risk number assigned by the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP).
• Surplus lines licensee number: The surplus lines licensee number preceded with SL, which is assigned by DIFP. 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 DIFP. Review the list of valid coverage types.
• Carrier code: The 3-digit number for each carrier assigned by DIFP. Review the list of valid carrier codes.
• Name of insured: The complete name of the insured.
• Premium amount debit: The dollar amount of the premium and fee charged. If no amount, submit as 0. Do not use dollar signs, commas or double quotation marks.  
• Premium amount credit: The dollar amount of any premium and fee reduction. If no amount, submit as 0. 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.

Step 2

• Send the Excel file attachment or text file to the Surplus Lines Section to be processed at surpluslines@insurance.mo.gov.
  
• In the body of the message, identify the following:
• Filing Type - Appendix 3.
• Producer's name and surplus lines licensee number.
• Producer's e-mail address.
• Contact person's name, e-mail address and phone number.