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Surplus Line Broker Forms

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Form #: GID-212-PT This is a Microsoft Excel Aplication\nDivision: Premium TaxPublished: 2013
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 PDF This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: Surplus Line Broker
SURPLUS LINE BROKER’S QUARTERLY PREMIUM TAX AFFIDAVIT. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: Surplus Lines Insurance Regulation (120-2-89) This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2008
Title: Surplus Lines Insurance Regulation (120-2-89)
Surplus Lines Insurance Regulation (120-2-89)

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