Signature
I understand this certification will be used to apply for a title in the insurance company’s name for this motor vehicle, trailer, all-terrain vehicle,
vessel, or watercraft and that any false statements in this certification will subject me to civil and criminal liability.
I certify under penalty of perjury that the facts herein are true to the best of my knowledge.
The signatory is an agent of the insurance company indentified above.
Signature of Authorized Agent or Owner
Printed Name Date (MM/DD/YYYY)
Mail to: Motor Vehicle Bureau
P.O. Box 2076 Phone: (573) 526-3669
Jefferson City, MO 65105-2076
Visit dor.mo.gov/motorv/ for additional information.
Form 5042 (Revised 04-2024)
Insurance Company Name Business Email Address
Street, Rural Route, or P.O. Box Telephone Number
City State ZIP Code County MO State Based Systems Number (SBS)
Form
5042
Application for Title by an Insurance Company
Instructions to Applicant: This form is to be used by insurance companies applying for a Missouri Certicate of Title after acquiring a
motor vehicle, trailer, vessel, watercraft, outboard motor, or all-terrain vehicle from an insured as the result of a settlement of a claim
for loss due to damage or theft. Insurance Companies will also utilize this form when applying for title in the name of and for use by the
insurance company.
Applicant address must be the insurance company’s physical address, not the salvage lot or auction.
Applicant InformationUnit Information
Year (YYYY) Make Identification Number (VIN/HIN/OBIN) Body Style
Title Number State of Current Title Date of Acquisition(MM/DD/YYYY) H.P. Fuel K.O.V Mileage
Acquisition as the Result of:
r Theft r Accident r Casualty Loss r Other ______________________________
r Hail r Flood
Percent
Damaged
%
Insured Information
Insured Name Total Loss Statement Issued Claim Number
Street Address City State Zip Code
r Yes r No
Mail title to the address below, if different from applicant address.
Mail To
Name
Street Address City State ZIP Code
Location of Unit
Street or physical address of unit location
City State ZIP Code
Fees
Title Fee
Local Tax
Sales Tax
Total
Processing or Agent Fee
__ __ / __ __ / __ __ __ __
Penalty
r Salvage r Junking Certificate r Vessel, Watercraft, or Outboard Motor - Original Title only
r Original Title - To qualify for an Original Title, the vehicle model year must be more than six years after the manufacturer’s model year designation
and the total cost of repairs to rebuild or reconstruct the vehicle to its condition immediately before it was damaged for legal operation on the roads or
highways is eighty percent or less of the fair market value of the vehicle immediately preceding the time it was damaged.
r Original Title Due to the Recovery of a Stolen Vehicle
__ __ / __ __ / __ __ __ __
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Application for Title by an Insurance Company Instructions
Motor Vehicle/Trailer
Insurance Company & Vehicle Is Titled In Missouri – No Title:
• Application for Title by an Insurance Company (Form 5042) – completed by insurance company & signed;
• Copy of proof of claim payment;
• Copies of 2 notication letters to the owner(s) and proof of 30 day notication, Form 5044;
• Copy of 1 notication letter to the lienholder and proof of 30 day notication, Form 5044 or lien release.
• $14.50 title & processing fees for Salvage or $6.00 processing fee for Junk.
Insurance Company & Vehicle Is Not Titled In Missouri – No Title:
• Application for Title by an Insurance Company (Form 5042) – completed by insurance company & signed;
- Insurance company must have a Missouri address, or if the insurance company is out of state, the vehicle must be located at a salvage pool in Missouri.
* If the insurance company or vehicle is not located in Missouri, the insurance company will need to apply for title in the state where the vehicle was last titled in, or in the
state where the insurance company is located.
• Vehicle Examination Certicate (Form 551) authorized by Missouri State Highway Patrol, St. Louis City or County Autotheft;
- Form 5062 inspection for trailers;
• Copy of notication letter to the owner(s) and proof of 30 day notication, Form 5044;
• Copy of notication letter to the lienholder and proof of 30 day notication, Form 5044 or lien release; and
• $14.50 title & processing fees for Salvage or $6.00 processing fee for Junk.
- An insurance company may apply for a Salvage title without payment of the title fee on a stolen vehicle when the application is made within 30 days of settlement. A
signed statement from the applicant that total loss was paid due to theft must be submitted.
Insurance Company Applying With Title:
• Vehicle no more than six years after the manufacture’s designation for such vehicle:
- A completed Application for Title by an Insurance Company (Form 5042) with the Salvage or Junk box marked, when applying for title in the name of and for use by the
insurance company, or model year must be more than six years after the manufacturer’s model year designation and the total cost of repairs to rebuild or reconstruct the
vehicle to its condition immediately before it was damaged for legal operation on the roads or highways is eighty percent or less of the fair market value of the vehicle
immediately preceding the time it was damaged.
- An assigned Manufacturer’s Statement of Origin (MSO), Original, or Salvage title.
- State and local tax, if applicable; OR
- Insurance companies are tax exempt (for total loss vehicles, only).
- Title penalty does not apply (for total loss vehicles, only).
- $14.50 title & processing fees for Salvage or $6.00 processing fee for Junk.
Insurance Company Applying With Title:
• Vehicle more than six years after the manufacture’s designation for such vehicle:
- A completed Application for Title by an Insurance Company (Form 5042) with the Original, Salvage, or Junk box marked.
- An assigned Manufacturer’s Statement of Origin (MSO), Original, or Salvage title.
- State and local tax, if applicable; OR
- Insurance companies are tax exempt (for total loss vehicles, only).
- Title penalty does not apply (for total loss vehicles, only).
- $14.50 title & processing fees for Original and Salvage or $6.00 processing fee for Junk.
Vessel or Watercraft
Insurance Company & Vessel, Outboard Motor Or Watercraft Is Titled In Missouri – No Title:
• A completed Application for Title by an Insurance Company (Form 5042) with the Original marked.
• Copy of the proof of claim payment;
• Copies of 2 notication letters to the owner(s) and proof of 30 day notication, Form 5044;
• Copy of 1 notication letter to the lienholder and proof of 30 day notication, Form 5044 or lien release;
- Evidence of the notices being sent include the tracking documentation from an established national postal or parcel delivery service (including but not limited to, the US
Post Ofce, Federal Express, or United Postal Service).
• State and local tax, if applicable; OR
• Insurance companies are tax exempt (for total loss vessel or watercraft, only).
• Title penalty does not apply (for total loss vessel or watercraft, only).
• $7.50 title fee; and
• $6.00 processing fee.
Insurance Company & Vessel Or Watercraft Is Not Titled In Missouri – No Title:
• A completed Application for Title by an Insurance Company (Form 5042) with the Original marked;.
- Insurance company must have a Missouri address, or if the insurance company is out of state, the vessel or watercraft must be located in Missouri;
* If the insurance company or vehicle is not located in Missouri, the insurance company will need to apply for title in the state where the vessel or watercraft was last titled
in, or in the state where the insurance company is located.
• Form 798 for inspection of Vessel or Watercraft;
• Copy of the proof of claim payment;
• Copy of the notication of the insurance company’s intent to apply for title and evidence that such notice was sent to owner.
• Copy of 1 notication letter to the lienholder and proof of 30 day notication, Form 5044 or lien release;
- Evidence of the notices being sent include the tracking documentation from an established national postal or parcel delivery service (including but not limited to, the US
Post Ofce, Federal Express, or United Postal Service).
• State and local tax, if applicable; OR
• Insurance companies are tax exempt (for total loss vessel or watercraft, only).
• Title penalty does not apply (for total loss vessel or watercraft, only).
• $7.50 title fee; and
• $6.00 processing fee.
- An insurance company may apply for a Salvage title without payment of the title fee on a stolen vessel or watercraft when the application is made within 30 days of
settlement. A signed statement from the applicant that total loss was paid due to theft must be submitted.
Insurance Company Applying With Title:
• A completed Application for Title by an Insurance Company (Form 5042) with the Original box marked.
• An assigned Manufacturer’s Statement of Origin (MSO), Original, or Salvage title.
• State and local tax, if applicable; OR
• Insurance companies are tax exempt (for total loss vessel or watercraft, only).
• Title penalty does not apply (for total loss vessel or watercraft, only).
• $7.50 title fee; and
• $6.00 processing fee.
Form 5042 (Revised 04-2024)