In an effort to accommodate you and your needs here at our website, we have provided a way for you to download the most current tax forms, tables, and instructions available from the Louisiana Department of Insurance by using the free Adobe Acrobat Reader program. This program has become an web industry standard for viewing and printing documents from the web. Click here to download the Acrobat Reader.
The language and format of the forms, tables, and instructions listed below, must not be altered.
Surplus Lines Producer Tax Filing Information
Form 1263.1 Approved Unauthorized Affidavit for Personal Surplus Lines Insurance
This form is required for any newly procured personal surplus lines policy, or for any personal surplus lines renewal where the insurer changes.
Form 1265 - Quarterly Surplus Lines Producer Tax Statement
This form should be used only by Licensed Louisiana Surplus Lines Producers to report surplus lines activity transacted in the State of Louisiana.
Form 1265 B - Self-Procured Unauthorized Insurance
This report must be filed by all individuals placing insurance with an unauthorized company without involving a licensed Louisiana Producer. The contract of insurance must be negotiated, paid, and delivered outside of Louisiana and in a state or other sovereignty where the company providing the coverage is admitted as an insurer. An individual other than a licensed Producer must have procured the coverage.
Industry Access - Click here to file tax forms online
Approved Unauthorized Insurer List -- Surplus Lines (White List)