Form E-Ar - Foreign And Alien Accredited Reinsurer Annual Fees Report - 2004
Download a blank fillable Form E-Ar - Foreign And Alien Accredited Reinsurer Annual Fees Report - 2004 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form E-Ar - Foreign And Alien Accredited Reinsurer Annual Fees Report - 2004 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1DEPARTMENT OF INSURANCE
STATE OF ARIZONA
FINANCIAL AFFAIRS DIVISION - TAX UNIT
th
2910 North 44
Street, Suite 210
Phoenix, Arizona 85018-7256
Phone: (602) 912-8429 Fax: (602) 912-8421
FOREIGN AND ALIEN ACCREDITED REINSURER ANNUAL FEES REPORT
DUE MARCH 1*
*DO NOT FILE THIS REPORT IF THE TOTAL ANNUAL FEES WILL BE PAID BY ACH DELIVERY.
SEE FORM E-ACH.INSTRUCTION FOR DETAILS REGARDING THE ACH PAYMENT OPTION.
Complete Company Name and Home Office Address
State of Incorporation
x
X
x
NAIC Number
x
NAIC Group Number
x
Federal I. D. Number
x
Preparer’s Name and Title:
E-Mail Address:
Toll Free or Collect Phone: (
)
FAX: (
)
Complete Mail Address:
1)
Certificate of Reinsurance Accreditation Renewal Fee
$
135.00
(Pay Code 58)
2)
Annual Statement Filing Fee
$
300.00
(Pay Code 28)
3)
TOTAL DUE MARCH 1
$
435.00
A
R
I
Z
O
N
A
D
E
P
A
R
T
M
E
N
T
O
F
I
N
S
U
R
A
N
C
E
A
R
I
Z
O
N
A
D
E
P
A
R
T
M
E
N
T
O
F
I
N
S
U
R
A
N
C
E
M
:
AKE CHECK PAYABLE TO
:
Attention: TAX UNIT
AND MAIL CHECK WITH REPORT TO
2910 North 44
Street, Suite 210
th
Phoenix, Arizona 85018-7256
FAILURE TO PAY THE CERTIFICATE OF AUTHORITY RENEWAL FEE MAY RESULT IN REVOCATION OF THE ARIZONA CERTIFICATE OF
REINSURANCE ACCREDITATION PURSUANT TO A.A.C. R20-6-1601(B)(6).
Payment by check must be sent with this Report by March 1. If March 1 falls on a Saturday or Sunday, the deadline will be extended to the following
Monday for that year only. STATUTORY PENALTIES FOR LATE FILING AND/OR PAYMENTS WILL BE ENFORCED.
PLEASE NOTE OUR "POSTMARK POLICY" APPLICABLE TO STATUTORY FILINGS, AS IT IS ENFORCED BY THIS DEPARTMENT: To be
considered a TIMELY filing, the package containing the filing must display validation by the United States Postal Service* as proof of the date of filing.
Courier deliveries must include an invoice bearing the date of courier pick-up. If your package does not provide evidence of a timely filing it will be
considered filed WHEN RECEIVED and statutory penalties, where applicable, will be assessed. *Postage meter stamps do not qualify.
IMPORTANT: DUE TO CASH CONTROL PROCEDURES DO NOT MAIL THE ANNUAL FEES REPORT FORM OR PAYMENT INSIDE AN ANNUAL
STATEMENT FILING PACKAGE. SEPARATELY MAIL YOUR CHECK WITH THIS REPORT TO THE ATTENTION OF TAX UNIT AT ADDRESS
SHOWN ABOVE.
E-AR (R
. 12/04)
P
1
1
EV
AGE
OF
ADVERTISEMENT
0 votes
Related Articles
Related forms
Unaffiliated Credit Life & Disability Reinsurer Annual Fees Report Form - Department Of Insurance - Arizona
Financial
Form E-arpc.as - Accredited Property/casualty Reinsurer - Foreign And Alien - Annual Statement Filings Worksheet - 2000
Legal
Related Categories
Parent category: Financial