Office of Insurance and Safety Fire CommissionerRalph T. Hudgens
Commissioner
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Domestic Life, HMO and Non-Profit Companies - 2013

ATTENTION: We have NEW IMPORTANT payment procedures. Please view them here.

Form #: GID-012A-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: Statement of Quarterly Premium Tax
Statement of Quarterly Premium Tax

Form #: GID-012V-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: Payment Voucher
When FILING quarterly or annual premium tax returns ELECTRONICALLY, complete this form and mail with your payment or payment ACH information. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

5/19/2013 8:55:12 PM
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