Registration Form Insurance Premiums Tax printable pdf download

Registration Form Insurance Premiums Tax

Government of Newfoundland and Labrador

Department of Finance

Taxation and Fiscal Policy Branch

Tax Administration Division

REGISTRATION FORM

INSURANCE PREMIUMS TAX

Remitter Number

(If you are currently registered for a tax program within the province)

Complete this form to apply for a Retail Sales Tax Licence to collect retail sales tax on the sale of insurance

premiums, or when required, to self-assess on insurance premiums paid in relation to risk occurring in the

Province of Newfoundland and Labrador.

Part A: General Business Information

PLEASE INDICATE BUSINESS TYPE

☐ Proprietorship ☐ Partnership ☐ Joint Venture ☐Association ☐ Corporation (attach copy of Certificate of Incorporation)

OWNERS’ AND DIRECTORS’ INFORMATION

Enter information for sole proprietor, or all partners, corporation directors or officers of the business.

If there are more than two, please provide same information on a separate sheet.

First Name

Last Name

Title

Phone Number

Email Address

( __ __ __ ) __ __ __  __ __ __ __

First Name

Last Name

Title

Phone Number

Email Address

( __ __ __ ) __ __ __  __ __ __ __

CONTACT INFORMATION

Should it be necessary to contact you for further information, please provide the following.

Contact First Name

Contact Last Name

Title

Phone

Facsimile

Email Address

( __ __ __ ) __ __ __  __ __ __ __

P.O. Box 8720, St. John’s, NL, Canada A1B 4K1 Telephone 1-877-729-6376

Fax (709) 729-2856

Registration Form Insurance Premiums Tax