Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Surplus Lines Insurance Forms and Information

Surplus Lines Broker – Tax Reports

Annual & quarterly tax reports are NOT required with policies filed through SLIP in the SL Clearinghouse. Zero filings are NOT required.

If you filed Endorsements to policies that have an original effective date before 1/1/13 that you had to file directly with the Division of Insurance then please complete an annual & quarterly tax report for those endorsements only.

Multi-State Surplus Lines Policies

In 2012, the South Dakota Division of Insurance (“Division”) became a signatory to the Nonadmitted Insurance Multi-State Agreement (“NIMA”) for the uniform filing and allocation of surplus lines premium taxes. (See Bulletin 12-03). On April 28, 2016, the Board of Directors of NIMA voted to wind-down operations and dissolve the organization. The Division issued Bulletin 16-05 as guidance to surplus line brokers regarding the filing of multi-state surplus lines policies.

The last day for brokers to report new multi-state policies to the Florida Surplus Lines Service Office (“FSLSO”) is September 30, 2016. Policy endorsements or cancellations for polices filed prior to September 30, 2016, may be reported to the FSLSO until September 30, 2017.

The FSLSO will continue serving as the Division’s vendor for all surplus lines filings and premium tax submissions. Beginning October 1, 2016, all new and renewal multi-state surplus lines policies will be filed as single-state policies with the FSLSO when South Dakota is the home state. If you have any questions regarding this process, you may contact the Division at 605.773.3563 or

Surplus Lines Clearinghouse Tax Calculator

SD Tax Rates Surplus Lines Clearinghouse Coverage Codes
(in Adobe .pdf format*)

Single-State Surplus Lines Policies

The Division now requires all surplus lines premium tax filings to be filed with the Clearinghouse. Due to this, all South Dakota surplus lines tax reporting and remittance will take place through the Clearinghouse website. Brokers are no longer required to file affidavits or surplus lines broker premium tax reports with the Division on surplus lines policies issued or renewed on January 1, 2013; this requirement is met by accurately supplying the required information at the Clearinghouse website. Brokers must report surplus lines business to the Clearinghouse within 30 days of the effective date of the policy. South Dakota brokers need to register with the Clearinghouse at its website to file policies.

Additional information can be found in Bulletin 12-06.

Insurance companies will continue to file with the Division using the following forms (many of which are available in Adobe .pdf format*).

Surplus Lines Insurance Company Forms

Surplus Lines Insurer Packet

Unauthorized Insurer Business Written Reports

Surplus lines policies in existence on January 1, 2013 and endorsements on those policies will continue to be filed with the Division until renewal. On those policies, the old forms will need to be used until renewal:

Self Procured Insurance and Premium Tax Report

Surplus Lines Broker Affidavit

Surplus Lines Uniform Application (from the National Association of Insurance

Surplus Lines Broker Premium Tax Report

Surplus Lines Broker Information

Surplus Line Renewals

Notice of Ineligibility for Surplus Lines Insurers

CNA Reinsurance Company Ltd.
CNA Law Dept, CNA Plaza
Chicago, IL 60685

Credit General Indemnity Company
3201 Enterprise Parway Ste 300
Beachwood, OH 44122

Legion Indemnity Company
One Logan Square, Suite 1400
Philadelphia, PA 19103

Reliance Insurance Company of IL
3 Parkway 6th Floor
Philadelphia, PA 19102

Western Indemnity Insurance Company
820 Gessner, Suite 1200
Houston, TX 77024

*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.




Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369