Form 20-Ins - Oregon Insurance Excise Tax Return - 2002 Page 4
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4SCHEDULE AF — SCHEDULE OF AFFILIATES
Domestic insurers, inter-insurance, and reciprocal exchanges. Use this schedule to list those affiliates doing business in Oregon
that are included in the consolidated return. (DO NOT INCLUDE the name shown on the heading of this return.) Use a copy of this
schedule to list additional affiliates, if necessary, and attach it directly behind this page.
If new affiliate during
If affiliate ceased to
Oregon
this year, enter date
be part of the unitary
Business ID Number
affiliate became part of
group, please indicate
Federal ID Number
Name and Address
unitary group
date affiliate left group
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Attach additional schedules if needed.
150-102-129 (Rev. 1-03)
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