Company Filing and Registration

This page contains tax filing, annual filing, premium filing, registration, and other reporting forms for Risk Retention Groups, Risk Purchasing Groups, Independently Procured Insurance (Surplus Lines), and Direct Placement/Self Procured Insurance (Licensed Company).

Use the index below to go directly to a particular section on this page:

• Annual Statement Filing Requirements
• Risk Retention Group Forms
• Risk Purchasing Group Forms
• Direct Placement/Self Procured Insurance (Licensed Company) Forms
• Independently Procured Insurance Forms
• Surplus Lines Insurance Forms
• Insurance Premium Tax

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Annual Statement Filing Requirements

Listed below are the Annual Statement Filing Requirements. Each link includes the National Association of Insurance Commissioners (NAIC) Checklist for the filing of the Annual Statement, including all subsequent supplements, licensing information, premium tax information, and the Mississippi Insurance Department state filing requirements. The NAIC Checklist indicates which documents should be filed with the Mississippi Insurance Department and with the NAIC.

• Accredited Reinsurer Annual Statement Filing Requirements (pdf) Updated 12/2017
• Alien Surplus Lines Companies Annual Filing Requirements (pdf)
• Automobile Club Annual Statement Filing Requirements (pdf) Updated 12/2017
• Burial Associations Annual Statement Filing Requirements (pdf) Updated 12/2017
• Foreign Surplus Lines Companies Annual Statement Filing Requirements (pdf)
• Fraternal Societies Annual Statement Filing Requirements (pdf) Updated 12/2017
• Health Insurers Annual Statement Filing Requirements (pdf) Updated 12/2017
• Health Maintenance Organization Annual Statement Filing Requirements (pdf) Updated 12/2017
• Life Health and Accident Companies Annual Statement Filing Requirements (pdf) Updated 12/2017
• Property Casualty Companies Annual Statement Filing Requirements (pdf) Updated 12/2017
• Risk Retention Groups Annual Statement Filing Requirements (pdf) Updated 12/2017
• Third Party Administrator Annual Statement Filing Requirements (pdf) Updated 12/2017
• Title Companies Annual Statement Filing Requirements (pdf) Updated 12/2017
• Trusteed Reinsurer Annual Statement Filing Requirements (pdf) Updated 12/2017

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Risk Retention Group Forms

• Annual Risk Retention Group Premium Filing Form
• Risk Retention Group Annual Statement Filing Requirements
• Risk Retention Group Registration Checklist
• Risk Retention Group Reporting Form
• For Annual and Quarterly Tax Filing Information contact the MID Accounting Division at 601-359-2310.

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Risk Purchasing Group Forms

• Annual Risk Purchasing Group Premium Filing Form
• Risk Purchasing Group Registration Checklist
• Risk Purchasing Group Reporting Form
• NAIC Uniform Service of Process Form
• For Annual and Quarterly Tax Filing Information contact the MID Accounting Division at 601-359-2310.

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Direct Placement/Self Procured Insurance (Licensed Company) Forms

• Direct Placement/Self Procured Insurance Form (Licensed Company)
• For Annual and Quarterly Tax Filing Information contact the MID Accounting Division at 601-359-2310.

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Independently Procured Insurance Forms

• Independently Procured Insurance Form
• For Annual and Quarterly Tax Filing Information contact the MID Accounting Division at 601-359-2310.

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Surplus Lines Insurance Forms

• Surplus Lines Eligibility Application
• Surplus Lines Name/Address Change
• Surplus Lines Premium Taxes are collected by the Mississippi Surplus Lines Association. Telephone: 601-713-1111. Website: http://www.msla.org.

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Insurance Premium Tax

Insurance premium tax filings are made through the Mississippi Department of Revenue. To obtain insurance premium tax forms, please visit the Insurance Premium Tax portion of their web site. If you have any questions regarding the filing of insurance premium taxes call 601-923-7700 or email derrick.barnes@dor.ms.gov

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