Self-Insurance (Religious Organization)
Statutory reference: Section 303.220, RSMo.
A religious organization which discourages 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 a private passenger motor vehicle registered in Missouri. The list must include the name and address of each member, and a description of each vehicle (year, make, VIN, and license plate number);
- A notarized affidavit from the minister, deacon, or officer of the church, certifying that, based on its religious tenets, the church discourages its members from purchasing insurance in any form and agrees to pay any judgment rendered against members of the church. A completed Self-Insurance Affidavit for Religious Groups (Form 5689) may be used for this purpose;
- A written explanation of how the church intends to pay for damages caused by a member involved in a motor vehicle accident; and
- Examples or statements showing how the church settled claims in the past.
The above items must be submitted to:Missouri Department of Revenue
PO Box 200
Jefferson City MO 65105-0200
Within two weeks of receiving your request, our staff will issue your electronic certificate of self-insurance and electronic identification cards, or issue a letter denying your request.