Form Gid-215-Pt - Risk Retention Groups Quarterly Premium Tax Affidavit Page 2

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preview the printed version before printing.
REMITTANCE
    • Click on the tab labeled “Remittance.”  If you are paying by ACH (electronic transfer), check the box labeled “ACH,” print the remittance voucher 
and mail a copy to the appropriate address.  
    • If you are paying by check, print the remittance voucher, enclose a check for the tax due and follow the mailing instructions listed on the page.
    • INCLUDE THE ORIGINAL SIGNED AND NOTARIZED AFFIDAVIT WITH YOUR PAYMENT.
Version Date:  2/7/2012

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