Premium Tax - Surplus Line Broker Forms

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Surplus Line Broker Forms

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Form #: GID-212-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: QUARTERLY PREMIUM TAX AFFIDAVIT - Single State Placements ONLY
SURPLUS LINE BROKER'S QUARTERLY PREMIUM TAX AFFIDAVIT. This form requires the broker's 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. This form may also be printed in blank. Use this form for single state placements only.

Form #: GID-212-PT $This is a Microsoft Excel Aplication\n$	Division: Premium Tax	Published: 2012
Title: QUARTERLY PREMIUM TAX AFFIDAVIT
SURPLUS LINE BROKER’S QUARTERLY PREMIUM TAX AFFIDAVIT WORKBOOK. Use this form for multi-state or single state placements. This is an Excel workbook that must be SAVED to your files before completing. This form requires the broker’s signature witnessed by a Notary Public with a notary seal. Instructions for completing the Excel workbook and filing the affidavit may be found at the first tab within the workbook.

Form #: GID-212-PT Zero Filings-No Business To Report $This is a Microsoft Excel Aplication\n$	Division: Premium Tax	Published: 2012
Title: SURPLUS LINE BROKER - No Business Zero Affidavit
Use this short form when there was no business to report for the quarter resulting in a zero filings. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: Quarterly Premium Tax Instructions
Provides detailed information on filing tax forms.

Form #: Surplus Lines Insurance Regulation (120-2-89) $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Surplus Lines Insurance Regulation (120-2-89)
Surplus Lines Insurance Regulation (120-2-89)

5/21/2012 4:18:46 PM

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