384.051.  Insured to file report on surplus lines insurance not obtained through a broker — contents, when due — tax imposed, procedure to collect tax. — 1.  Every insured whose home state is this state who procures or causes to be procured or continues or renews insurance in any surplus lines insurer, or any self-insurer whose home state is this state who so procures or continues with, any surplus lines insurer, excess of loss, catastrophe or other insurance, other than insurance procured through a surplus lines broker pursuant to sections 384.011 to 384.071, shall before March second of the year next succeeding the year in which the insurance was so procured, continued or renewed, file a written report of the same with the director on forms prescribed by the director and furnished to such an insured upon request.  The report shall show:

  (1)  The name and address of the insured or insureds;

  (2)  The name and address of the insurer or insurers;

  (3)  The subject of the insurance;

  (4)  A general description of the coverage;

  (5)  The amount of premium currently charged therefor;

  (6)  Such additional pertinent information as may be reasonably requested by the director.

  2.  For the general support of the government of this state there is levied upon the insured or self-insurer who procures insurance pursuant to subsection 1 of this section a tax at the rate of five percent of the gross amount of the premium.  Before April sixteenth of the year next succeeding the year in which the insurance was so procured, continued or renewed, the insured shall remit to the department of revenue the amount of the tax.  The department of revenue shall notify the director of the sums collected from each insured or self-insurer.