The Surplus Line Association of Utah

6711 South 1300 East
Salt Lake City, UT 84106

Phone 801-467-8421 or Fax 801-467-7673

The following statement of premium, written by non-admitted insurers is hereby offered for filing, pursuant to the provisions of the Utah Insurance Code and applicable rules of the Utah Insurance Department.

Please use the following link to download the Utah risk purchasing group - surplus lines taxes form, which you will then need to print out and mail in with your payment. Thank you.

Download the Utah risk purchasing group - surplus lines taxes form (87kb) Right-click and choose 'Save Target As...'

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