Form 20-Ins - Oregon Insurance Excise Tax Return - 2013 Page 3
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Schedule AF: Schedule of Affiliates for Form 20-INS
Domestic insurers, inter-insurance, and reciprocal exchanges. Use this schedule to list only those affiliates doing business in Oregon
that are included in the consolidated return.
Do not include in this list the corporation filing this tax return. You may copy this form if you have more than 10 affiliates to include on
this list.
If affiliate ceased to
If new affiliate during
be part of the unitary
this year, enter date
group during the year,
FEIN and BIN
Name and Address
affiliate became part
indicate date affiliate
of the unitary group
left group
•
•
FEIN #1
Name
•
•
•
Address
BIN #1
•
•
FEIN #2
Name
•
•
•
Address
BIN #2
•
•
FEIN #3
Name
•
•
•
BIN #3
Address
•
•
FEIN #4
Name
•
•
•
BIN #4
Address
•
•
FEIN #5
Name
•
•
•
BIN #5
Address
•
•
FEIN #6
Name
•
•
•
Address
BIN #6
•
•
FEIN #7
Name
•
•
•
Address
BIN #7
•
•
FEIN #8
Name
•
•
•
BIN #8
Address
•
•
FEIN #9
Name
•
•
•
BIN #9
Address
•
•
FEIN #10
Name
•
•
•
BIN #10
Address
Attach additional schedules if needed
Form 20-INS, page 3 of 3
150-102-129 (Rev. 10-13)
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