2011 Form Aid Ac Ci-T - Annual Report Of Premiums, Taxes, And Fees Of All Captive Insurance Companies - Arkansas Insurance Department

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ARKANSAS INSURANCE DEPARTMENT
2011 FORM AID AC CI-T
ACCOUNTING DIVISION
1200 WEST THIRD STREET
LITTLE ROCK, AR 72201-1904
PHONE: (501) 371-2605
PREMIUM TAX INSTRUCTIONS
CAPTIVE INSURERS
All tax filings and payments must be received on or before March 1, 2012; the Department does not accept the
postmark date. No authority exists for granting any extension of time for filing or payment. Any insurer that
fails to report or pay tax will be subject to penalty in accordance with ACA 26-57-607.
The Department does not accept software forms. The forms must be completed and printed on our website.
/accounting/divpage.htm
If you are filing by EFT, send the additional documents from the checklist to the address below
with the name of the company and NAIC number clearly identified.
Mail the return, documentation, and check to:
Arkansas Insurance Department
Accounting Division
1200 West Third Street
Little Rock AR 72201-1904
For questions concerning the completion of tax forms, contact the Accounting Division at (501) 371-2605 or
email us at:
insurance.accounting@arkansas.gov
CI-T CHECKLIST:
1. 2011 FORM AID AC CI-T (ANNUAL REPORT OF PREMIUMS, TAXES AND FEES); WITH
CHECK ATTACHED
2. 1 COPY OF 2011 ARKANSAS STATE BUSINESS PAGE
3. 1 COPY OF SCHEDULE T
DO NOT INCLUDE WITH THE PREMIUM TAX FILINGS:
CORPORATE FRANCHISE TAX:
Remit to the Secretary of State’s Office, Attention: Lisa Bruno,
1401 Capitol Ave., Victory Bldg., Suite 250, Little Rock AR 72201.
MAIL TO ADDRESS ON THE FORM
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