Wis. Admin. Code § Ins 6.17
(2) Prohibited placement. No licensed surplus lines agent may place contracts of insurance with any unauthorized insurer:
(3) Responsibilities of surplus lines agent. Every licensed surplus lines agent who procures surplus lines insurance shall:
(c) Keep in his or her office in this state a full and true record of each surplus lines insurance contract procured by him or her, evidenced by a copy of the daily report or other documents to show at least the following information:
(6) Penalty. Any violation of this rule shall subject the agent to immediate revocation of the agent’s surplus lines license and to other forfeitures and penalties provided by s. 601.64, Stats.
Ins 6.17 Appendix 1
SURPLUS LINES INSURANCE PROPOSAL
Name and address of applicant Date
Dear: Proposal No.
You have asked that I procure the following insurance coverage on your behalf:
Type of Insurance Limits of Coverage
I can procure the coverage desired from the following insurer(s) at the premium listed:
Insurer(s) — Name and Address % of Total Risk
Premium Quoted
This insurance is with an insurer which has not obtained a certificate of authority to transact a regular insurance business in the state of Wisconsin, and will be issued and delivered as a surplus lines coverage pursuant to s. 618.41, Stats. The insurance is regulated by the Commissioner of Insurance only as provided in ss. 618.41 and 618.43, Stats. Section 618.43 (1), Stats., requires payment by the policyholder of a 3% tax on gross premium (except for Ocean Marine Insurance on which the tax is one-half of 1%). The tax in this instance amounts to $ . If the above transaction is not satisfactory, please advise immediately.
Sincerely yours,
______________________________________________
Name and address of licensed surplus lines agent
Note: 2011 Wisconsin Act 224 changed the tax rate for surplus lines insurance which is ocean marine insurance to the same 3% rate for all other surplus lines insurance. Any previous reference to a ½ of 1% rate for ocean marine insurance in this rule is not enforceable as that insurance is now taxed at the same 3% rate for all surplus lines insurance.
History: Cr. Register, December, 1973, No. 216, eff. 1-1-74; am. (1), Register, May, 1975, No. 233, eff. 6-1-75; emerg. am. (2) (a) and (b), eff. 6-22-76; am. (2) (a) and (b), Register, September, 1976, No. 249, eff. 10-1-76; am. (2) (a) and (b), Register, March, 1979, No. 279, eff. 4-1-79; r. (3) (c), renum. (3) (d) and (e) to be (3) (c) and (d), am. (4), (6) and appendix 1, Register, August, 1982, No. 320, eff. 9-1-82; corrections in (3) (c) (intro.) made under s. 13.93 (2m) (b) 5., Stats., Register, April, 1992, No. 436, eff. 5-1-92; CR 22-076: am. (5), r. appendix 2 Register July 2023 No. 811, eff. 8-1-23.