Instructions For Annual Premium Tax And Fees Report Form November 2009
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1
2Department of Insurance
State of Arizona
ANNUAL PREMIUM TAX AND
Financial Affairs Division – Tax Unit
FEES REPORT INSTRUCTIONS
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269
Phone: (602) 364-3997 | Fax: (602) 364-3989
Determine the forms you need from the listing below and download them from our web site at
or find them posted on the NAIC OPTins web site. To determine your
business type, visit our insurer lookup web page at If your business
type is not listed or you need assistance, call (602) 364-3999 and provide your NAIC Number.
LISTING OF TAX AND FEE REPORT FORMS BY BUSINESS TYPE
BUSINESS TYPE
FORM NAME
DUE DATE
E-RG
3/01
FOREIGN RISK RETENTION GROUP
th
15
of each month,
*
E-INSTALLMENT TAX
March-August*
E-ANNUALFEES
3/01
FOREIGN TITLE INSURER
E-TITLE.RETALIATORY
4/15 OR 10/15
FRATERNAL BENEFIT SOCIETY
E-FRATERNAL
3/01
E-HEALTHORG
3/01
HEALTH CARE SERVICES ORGANIZATION or
HOSPITAL, MEDICAL, DENTAL AND OPTOMETRIC
th
15
of each month,
SERVICE CORPORATION (“HMDO”)
*
E-INSTALLMENT TAX
March-August*
E-LD
3/01
LIFE / DISABILITY INSURER
th
15
of each month,
*
E-INSTALLMENT TAX
March-August*
E-PC
3/01
MORTGAGE GUARANTY INSURER
th
15
of each month,
*
E-INSTALLMENT TAX
March-August*
E-HEALTHORG
3/01
PREPAID DENTAL PLAN ORGANIZATION
th
15
of each month,
*
E-INSTALLMENT TAX
March-August*
E-PC
3/01
PREPAID LEGAL INSURER or
PROPERTY / CASUALTY INSURER
th
15
of each month,
*
E-INSTALLMENT TAX
March-August*
– If your net annual tax liability is $2,000 or more, you must pay tax installments due
*E-INSTALLMENT TAX
th
the 15
of each month from March through August equal to15% of your annual tax liability amount.
•
DO NOT file installment reports or pay installment tax if your annual tax liability is less than $2,000.
•
DO NOT combine installment tax payments with the annual tax/fee payment.
•
DO NOT send installment reports or tax payments inside your Annual Statement package – all tax and
fee payments must be sent to the Tax Unit.
E-ANNUALTAX.INSTRUCTION (Rev. 11/09)
Arizona Department of Insurance
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