Surplus Lines Insurance Forms and Information
Multi-State Surplus Lines Policies
After the passage of the Nonadmitted and Reinsurance Reform Act (NRRA), South Dakota enacted enabling legislation to join multi-state agreements concerning surplus lines insurance and became a signatory to the Nonadmitted Insurance Multi-State Agreement (NIMA). NIMA functions to provide uniform filing and allocation of surplus lines premium tax when a NIMA participating state is the “Home State” under the provisions of the NRRA and the policy includes premium for an exposure in more than one state/territory, regardless of NIMA participation status.
For multi-state surplus lines policies, the affidavit requirement in South Dakota is satisfied by accurately supplying the required information at the Clearinghouse.
The Clearinghouse website contains information, training opportunities, filing instructions and contact information.
Additional information can be found in Bulletin 12-03.
News from the Director on Nonadmitted Insurance Multistate Agreement (NIMA)
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
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
Commissioners)
Surplus Lines Broker Premium Tax Report
Surplus Lines Broker Information
Notice of Ineligibility for Surplus Lines Insurers
06/26/2001
CNA Reinsurance Company Ltd.
CNA Law Dept, CNA Plaza
Chicago, IL 60685
06/26/2001
Credit General Indemnity Company
3201 Enterprise Parway Ste 300
Beachwood, OH 44122
11/12/2002
Legion Indemnity Company
One Logan Square, Suite 1400
Philadelphia, PA 19103
06/26/2001
Reliance Insurance Company of IL
3 Parkway 6th Floor
Philadelphia, PA 19102
07/09/2001
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.
445 E. Capitol Avenue
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369
