Statutory reference: Section 303.220, RSMo.

A religious organization which prohibits its members from purchasing insurance and has at least 26 members with private passenger motor vehicles registered in Missouri, may apply for a certificate of self-insurance by submitting the following:

  • A written request to be considered for self-insurance, signed by an officer of the church, on church letterhead;
  • A list of at least 26 church members, each owning private passenger motor vehicles registered in Missouri. The list must include the name and address of each member, and a description of each vehicle (year, make, VIN, and plate number);
  • An affidavit from the minister, deacon, or officer of the church, certifying that based on its religious tenets, the church prohibits its members from purchasing insurance in any form;
  • A written explanation of how the church intends to pay for damages caused by a member involved in a motor vehicle accident;
  • Examples or statements showing how the church settled claims in the past; and
  • A completed Agreement to Pay Judgments (Form 5317).

The above items must be submitted to:

Missouri Department of Revenue
ATTN: Self-Insurance
PO Box 200
Jefferson City MO 65105-0200

Within two weeks of receiving your request, our staff will issue your certificate of self-insurance and identification cards, or issue a letter denying your request.