Form E-Indins - Industrial Insured Premium Receipts Tax Report For The Period Of January 1 - July 20, 2011 Page 2

Download a blank fillable Form E-Indins - Industrial Insured Premium Receipts Tax Report For The Period Of January 1 - July 20, 2011 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-Indins - Industrial Insured Premium Receipts Tax Report For The Period Of January 1 - July 20, 2011 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

Complete Name of Insured
SECTION D: QUALIFIED RISK MANAGER.
D1 - Last Name
First Name
Middle Name
Jr./Sr./II/III/etc.
D2.
Indicate which of the following qualifications the risk manager satisfies. Provide information for all that
apply.
Baccalaureate or higher degree in risk management issued by an accredited college or
university.
Name of college/university: ________________________________________________________
Major/field of study: ______________________________________________________________
Graduation month/year: _______ / _______
Name of college/university: ________________________________________________________
Major/field of study: ______________________________________________________________
Graduation month/year: _______ / _______
Designation as a chartered property and casualty underwriter that is issued by an insurance
institute.
Name of insurance institute: ________________________________________________________
Month/year issued: _______ / _______
Designation as a certified insurance counselor that is issued by a society of certified insurance
counselors
Name of society: _________________________________________________________________
Month/year issued: _______ / _______
Designation as an associate in risk management that is issued by an insurance institute.
Name of insurance institute: ________________________________________________________
Month/year issued: _______ / _______
Designation as a certified risk manager that is issued by a national alliance for insurance
education and research.
Name of alliance: ________________________________________________________________
Month/year issued: _______ / _______
Designation as a fellow in risk management that is issued by a global risk management
institute.
Name of institute: ________________________________________________________________
Month/year issued: _______ / _______
Other similar qualification, other than insurance producer license, that the director of
insurance should consider sufficient. Describe the qualification and when it was attained in
the space provided below.
_________________________________________________________________________________
X
None.
Form E-IndIns (v20111027)

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-ii - Industrial Insureds Premium Receipts Report - 2015 Form E-ii - Industrial Insureds Premium Receipts Report - 2015 Financial
Form It-40pnr - Schedule Ct-40pnr - County Tax Schedule For Part-year And Full-year Indiana Nonresidents - 2011 Form It-40pnr - Schedule Ct-40pnr - County Tax Schedule For Part-year And Full-year Indiana Nonresidents - 2011 Financial
Form It-141 - West Virginia Fiduciary Income Tax Return (for Resident And Non-resident Estates And Trusts) - 2011 Form It-141 - West Virginia Fiduciary Income Tax Return (for Resident And Non-resident Estates And Trusts) - 2011 Financial
Form Iip - Quarterly Industrial Insurance Premium Tax Return Form Iip - Quarterly Industrial Insurance Premium Tax Return Financial
Form W-1 - Employer's Report Of Taxes Withheld For The Village Of Addyston, Ohio Form W-1 - Employer's Report Of Taxes Withheld For The Village Of Addyston, Ohio Financial
Form Uz-50 - Return For The Month Of January, 2010 Form Uz-50 - Return For The Month Of January, 2010 Financial
Form W-1 - Employer's Quarterly Return Of Taxes Withheld For The Village Of Batavia Form W-1 - Employer's Quarterly Return Of Taxes Withheld For The Village Of Batavia Financial
Form W-1 - Employer's Quarterly Return Of Taxes Withheld For The Village Of Batavia Form W-1 - Employer's Quarterly Return Of Taxes Withheld For The Village Of Batavia Financial
Form Rct-113 - Gross Receipts Tax Report Transportation Business - Commonwealth Of Pennsylvania Department Of Revenue Form Rct-113 - Gross Receipts Tax Report Transportation Business - Commonwealth Of Pennsylvania Department Of Revenue Financial
Form Uz - 50 - Combined State Sales And Use Tax/urban Enterprise Zones Sales Tax Return For The Month Of Form Form Uz - 50 - Combined State Sales And Use Tax/urban Enterprise Zones Sales Tax Return For The Month Of Form Financial

Related Categories

Parent category: Financial
Download
Go
Page of 5