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Indiana Department of Insurance

IDOI > Producer and Agency Licensing > Agents > Resident Licensing > Surplus Lines > Monthly Affidavits Surplus Lines Monthly Affidavits

The Monthly Report Affidavit and Monthly Report Excel Spreadsheet are to be filed monthly (only if business is written) by the 20th of each month so that surplus lines producers pay the appropriate premium tax.  The Monthly Affidavits must meet the following requirements:

  • Reflect amounts for gross premiums (which include agency fees, policy fees, etc.) written during the given month.
  • Be grouped and sub-totaled by the name of the company business was placed with.
  • Provide a total of gross premiums written and premiums returned.
  • Provide a grand total of premiums written subtracting premiums returned.
  • Reflect the full company name not the group name, and the company’s NAIC number.
  • Reflect per policy written, 3 refusals of coverage from admitted companies.
  • Report business written with authorized surplus lines companies.

If the company is not authorized, the Department will send a letter to the producer indicating so.

  • Policy binders or declaration pages are not required.
  • Reports filed by the twentieth are for the prior months’ business (e.g. January 2007 report should be filed by February 20, 2007).
  • If a revision is made a revised monthly report must be:
    • Filed with the Department
    • Clearly marked “revised”
    • Submitted with signatures
    • Accompanied by a cover letter explaining the revision
    • Accompanied by a revised affidavit with signatures

Monthly Report

Monthly Affidavit

Monthly Reports and Affidavits should be mailed to the following: 

Surplus Lines Coordinator
Indiana Department of Insurance
311 W. Washingtion Street, Suite 300
Indianapolis, IN  46204-2787