Form E-Rg - Foreign Risk Retention Group Annual Tax Report Page 5

Download a blank fillable Form E-Rg - Foreign Risk Retention Group Annual Tax Report 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-Rg - Foreign Risk Retention Group Annual Tax Report 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

COMPANY NAME:
State Of Incorporation:
NAIC#:
YEAR:
AGENT FEES (for Retaliatory Taxes and Fees Worksheet)
You are not required to complete this page if you answered NO to questions A and B on Page 1.
You must separately file E-AZAGENTS.XLS to provide the required Arizona agent data for your total
counts entered below.
If you wrote business in Arizona but you had no Arizona Agents provide an explanation below and
enter “0” in lines A and B, D and E to complete the Part(s) that apply to you.
PART I –AGENT APPOINTMENT FEES -
YOU MUST COMPLETE THIS PART IF YOU ANSWERED YES
TO QUESTION A ON PAGE 1
State of Incorporation
A
Total count of Column 2 from E-AZAGENTS.XLS
#
Agent appointment fee charged by your state during calendar year of
B
this report (Exclude late fees)
X $
0.00
C
Total agent appointment fees
$
PART II –AGENT TERMINATION FEES -
YOU MUST COMPLETE THIS PART IF YOU ANSWERED YES
TO QUESTION B ON PAGE 1
State of Incorporation
D
Total count of Column 3 from E-AZAGENTS.XLS
#
Agent termination fee charged your state during the calendar year of
E
this report. (Exclude late fees)
X
$
0.00
F
Total agent termination fees
$
E-RG (11/09)
Arizona Department of Insurance
Page 5 of 7
Go to Page 7

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form E-rrg.as - Risk Retention Group - Foreign And Alien Annual Statement Filings Worksheet - 2000 Form E-rrg.as - Risk Retention Group - Foreign And Alien Annual Statement Filings Worksheet - 2000 Legal
Form I-71-20-b - Employer's Annual Tax Report Form I-71-20-b - Employer's Annual Tax Report Financial
Form I-71-20-b - Employer's Annual Tax Report Form I-71-20-b - Employer's Annual Tax Report Financial
Form Gid-215-pt - Risk Retention Groups Quarterly Premium Tax Affidavit Form Gid-215-pt - Risk Retention Groups Quarterly Premium Tax Affidavit Financial
Form E-lr - Domestic Life & Disability Reinsurer Annual Fees Report - 2004 Form E-lr - Domestic Life & Disability Reinsurer Annual Fees Report - 2004 Financial
Form E-title.d - Domestic Title Insurer Annual Fees Report - 2000 Form E-title.d - Domestic Title Insurer Annual Fees Report - 2000 Financial
Statement Of Premiums And Fees For Taxation (to Be Filed On Or Before March 1) Foreign Risk Retention Groups Statement Of Premiums And Fees For Taxation (to Be Filed On Or Before March 1) Foreign Risk Retention Groups Financial
Form Vt Sto Upd 001 - Unclaimed Property Annual Compliance Report Form Vt Sto Upd 001 - Unclaimed Property Annual Compliance Report Legal
Form Wv/raffle-4 - Schedule For Raffle Annual Financial Reports Form Wv/raffle-4 - Schedule For Raffle Annual Financial Reports Financial
Form 12-100/12-101 - Texas Hotel Occupancy Tax Report Form 12-100/12-101 - Texas Hotel Occupancy Tax Report Financial

Related Categories

Parent category: Financial
Download
Go
Page of 7