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Accounting Division

Phone: (501) 371-2605

Fax: (501) 682-6679

Email: insurance.accounting@arkansas.gov

SURPLUS LINES BROKER TAX FILING FORMS & INSTRUCTIONS

PURSUANT TO ARKANSAS CODE §23-65-301, ET SEQ., AND RULE 24

ON SURPLUS LINE INSURANCE

Licensing of Surplus Lines Brokers: see AR Code §23-65-308

Arkansas Surplus Lines Brokers Courtesy Filing List

Use this list to choose a broker for your filings if you are not licensed in Arkansas

as a surplus lines broker.

Although many licensed surplus line brokers adhere to the Insurance Code, and Department Rule 24, in making timely reports and tax filings, a few are consistently delinquent in filing Forms SL-2 and SL-2A and/or remitting the 4% broker’s tax by the required due dates and incur monetary penalties. To facilitate timely report and tax filings, please adhere to the following chart for a calendar year:

Filing Deadlines for

Month Coverage Form SL-2 & SL-2A

is Procured and Tax Payments

January…………………………… April 1 (Leap Year March 31)

February………………………..… April 29 (Leap Year April 30)

March……………………………… May 30

April……………………………….. June 29

May………………………………… July 30

June……………………………….. August 29

July………………………………… September 29

August…………………………….. October 30

September………………………... November 29

October…………………………… December 30

November………………………… January 29

December………………………… March 1 (Leap Year February 29)

THIS DEPARTMENT DOES NOT ACCEPT POSTMARK DATES AS EVIDENCE OF FILING.

NOTE: The forms attached to the bulletins & rules are not to be used. The forms have been updated under separate links below, and the bulletins are being rescinded, effective July 1, 2005. Use the forms listed under the “Forms” header immediately below the Rule linked below.

Rule 24 Surplus Lines Insurance

(please use the forms below-not the ones attached to the rule)

FORMS

Forms to be sent to the Accounting Division:

SL-2 Affidavit of Surplus Line Broker (form includes Page SL-2A, which should be copied for extended use.) The person signing this form MUST be licensed
in Arkansas as a surplus lines broker.

NOTE: If a surplus line broker has a “zero” monthly filing, the broker is not required to send a form to the Department.

SL-4 Annual Statement of Surplus Line Broker (due by March 1^st each year.)

The person signing this form MUST be licensed in Arkansas as a surplus
lines broker. ANNUAL FORM MUST BE SENT EVEN IF ZERO.

Forms to be kept on file in the Surplus Line broker’s office:

Conditions of Procurement – Broker’s Documentation of Compliance with Rule 24

SL-3 Disclosure to Surplus Line Insured

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