Premium Tax Reporting Form for Directly Placed Insurance

Premium Tax Reporting Form for Directly Placed Insurance

The Surplus Line Association of Utah

6711 South 1300 East
Salt Lake City, UT 84106

Phone 801-944-0114 or Fax 801-944-0116

Persons seeking insurance may obtain the insurance from an unauthorized insurer if no agent or broker resident doing business in Utah is involved and if negotiations occur primarily outside Utah. (Such negotiations do not include insurance-related solicitations or negotiations by mail, telephone, or facsimile).

Utah law requires that premium tax be paid for insurance written on all risks located in Utah. A stamping fee (processing fee) is also due. The insured and/or policyholder is responsible for paying this tax within 60 days after the insurance is procured or renewed.

Please use the following link to download the Premium Tax Reporting Form for Directly Placed Insurance form, which you will then need to print out and mail in with your payment. Thank you.

Download the Premium Tax Reporting Form for Directly Placed Insurance form

NOTE: A check for the tax and fee must be sent to the Surplus Line Association of Utah to accompany this form.