Sample Tax Data

A subscription to Insurance Tax Services will give you access to Surplus Lines tax information for all 50 states plus Guam and Puerto Rico. Below is sample data for Alaska which provides representative information.

Insurance Tax Information for Sample

Tax Information Tax Calculator
Tax Rate (%)2.7% of
Base & Fee 
Stamping Fee Rate (%)1% of
Base & Fee 
Submission Requirements

Copy of Policy, Filing Fee must be shown on Dec and Taxed

CLICK HERE for all Alaska forms.

Time Limits:Quarterly 
Requirements:
Binder?
Affadavit?
Notarized?
Stamp?
Courtesy Filing?
Notes About Sample

This is a sample of data you can expect to find within the Notes section.

Surplus lines may be used only when full amount or kind of insurance cannot be obtained from admitted insurers. They may not be used to secure a better rate. The broker's annual statement is subject to audit. The broker must file a certificate affirming that insurer's capitalization meets Hawaii's minimum capitalization requirements under H.R.S. Sec. 431:8-302. All insurance contracts must be initialed by or bear the name of the surplus lines broker and be stamped as follows:

This insurance contract is issued by an insurer which is not licensed by the State of Hawaii and is not subject to its regulation or examination. If the insurer is found insolvent, claims under this contract are not covered by any guaranty fund of the State of Hawaii.

Hawaii does not have a surplus lines stamping office.

Sample Filing Forms
(click to download)

Surplus Lines Filing Confirmation Form (37.6689453125 KB)
Evidence of Compliance (31.482421875 KB)
Premium Tax Report (Annual) (220.8740234375 KB)
Procured with Unauthorized Insurer (84.94140625 KB)
Quarterly Tax Report (196.9697265625 KB)