Premium Tax - Procurement Forms
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| Form Number: GID-214-PT |   | | Title: REPORT OF PERSON(S) PROCURING INSURANCE | Published: 2011 | Description: REPORT OF PERSON(S) PROCURING INSURANCE FROM UNAUTHORIZED INSURERS. This form requires the signature witnessed by a Notary Public with a notary seal. This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us.
FOR MULTI-STATE POLICIES, PLEASE ATTACH A SCHEDULE THAT REFLECTS THE NAME OF EACH STATE ALLOCATED RISK ALONG WITH THE AMOUNT OF PREMIUM ALLOCATED TO EACH STATE. |
| Form Number: Instructions | | | Title: Quarterly Premium Tax Instructions | Published: 2009 | | Description: Provides detailed information on filing tax forms. |
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