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

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Form #GID-012-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: Annual Premium Tax Return
Annual Premium Tax Return
PID:1062-SID:2730-FN:GID-012-PT AnnPremTaxRet_rev10092013.pdf

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
PID:1039-SID:2661-FN:GID-012A-PT-2013.pdf

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.
PID:1055-SID:2718-FN:GID-012V-PT.pdf

Form #GID-014-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: 2013 Calculation For Abatement Of Gross Premium Tax
2013 Calculation For Abatement Of Gross Premium Tax. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.
PID:1069-SID:2758-FN:GID-014-PT CalcAbatementGrossPremTax_rev10112013_RDR.pdf

Form #GID-203-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: 2013 Reconciliation Statement Annual Premium Tax Return
2013 Reconciliation Statement Annual Premium Tax Return
PID:1066-SID:2746-FN:GID-203-PT 2013 Reconcil Stmt Annl Prem Tax Ret_Rev10152013.pdf

Form #GID-205-PT This is in the Adobe Portable Document format (pdf)\nDivision: Premium TaxPublished: 2013
Title: 2013 Insurance Premium Tax Credits
2013 Insurance Premium Tax Credits
PID:1067-SID:2750-FN:GID-205-PT 2013 Ins Prem Tax Credits_rev10112013.pdf

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