Form Sl 3 - Surplus Lines Statement Of Premiums And Tax Payment
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2STATE OF TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
Surplus Lines Division
500 James Robertson Parkway, 4th Floor
Nashville, TN 37243
(615) 741-1756
PROCEDURES FOR PAYING SURPLUS LINES TAXES
Note: Filings for zero or no business written not required
Form SL 3 Surplus Lines Statement of Premiums and Tax Payments (IN-0129) must be completed and mailed
with all tax payments. The agency that fills out and files the Form SL 2 Affidavit for Placing Surplus Lines
Insurance is the agency that fills out and files the Form SL 3 Surplus Lines Statement of Premiums and Tax
Payments and submits the taxes to Tennessee (see Procedures for Paying Surplus Lines Taxes for detailed
instructions).
The link for the form is located at
Taxes are due by September 1 for all filings with an effective date of January 1 through June 30
Taxes are due by March 1 for all filings with an effective date of July 1 through December 31
Optional: you have the option of remitting the tax payment when the affidavit is filed or on a monthly basis
If you believe there's credit due from a prior tax period and you're reducing the amount of tax due in this tax
period, please indicate on the Form SL 3 or in a cover letter the amount of tax credit due and the prior tax period.
Paper filings: If you file paper affidavits, the reconciliation must be attached to the Form SL 3 when remitting the
tax payment. Total premiums and tax amounts shown must agree with the sums of all affidavits filed with this
Department for the same tax period. The reconciliation should include the name of the policyholder, policy
number, effective date, amount of premium, and amount of tax. If you wish to receive information regarding the
electronic spreadsheet, send an email to Surplus.Lines@tn.gov requesting the information.
Electronic spreadsheet filings: If you file electronic affidavits, indicate on the SL 3 the date(s) of when the
filings were emailed. If some of the filings during the tax period included paper affidavits, indicate on the SL 3
that there were paper affidavits filed also (attach reconciliation to the Form SL 3 - see above for detailed
instructions).
Make check payable to:
Tennessee Department of Commerce & Insurance
Mail check to:
State of Tennessee
The Department of Commerce & Insurance
P.O. Box 198983
Nashville, TN 37219-8983
If you have any questions concerning this matter or need assistance in filling out the forms, please contact the Surplus
Lines Division at (615) 741-1756 or Surplus. Lines(a).tn. gov.
Revised 7-2010
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