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To file Zero for your Surplus Line Tax or Insurance Company Tax please fill out the following form. 

NOTE: (DO NOT MAIL THE QUARTERLY FORM if you are completing the below electronic filing).

1. Choose [NPN]  or  [NAIC]
2. Enter the NPN or NAIC # 
3. Choose the Quarter
4. [Click to begin Search]

if the number is found the Name/Company name will be displayed. Enter your Contact information and then you must check "I verify the above information is correct" checkbox.  Additional info will be displayed but not editable. 

To submit the data you must check the checkbox "I AGREE"  and then click the button [Submit Data]

“NOTE:  4th quarter zero filings are not accepted through this option. 
YOU MUST complete the Annual Tax Packet.”

  


Name / Company:
Contact First Name: Contact Last Name:
Phone Number: E-Mail:
:I verify the above information is correct
# Description Tax# $
1 4% SURPLUS LINES TAX PAYABLE 20 0.00
2 0.55% SURCHARGE PAYABLE 30 0.00
3 TOTAL AMOUNT REMITTED 0.00
# Description Tax# $
1 3% PREMIUM TAX PAYABLE 10 0.00
2 1% ANNUITY TAX PAYABLE 11 0.00
3 1% ADDITIONAL PAYABLE 20 0.00
4 0.55% SURCHARGE PAYABLE 30 0.00
5 DEBT REDUCTION SURCHARGE 32 0.00
6 REGULATORY SURCHARGE 34 0.00
7 FIRE MARSHAL TAX PAYABLE 40 0.00
8 RETALIATORY FEE PAYABLE 50 0.00
9 RETALIATORY TAX PAYABLE 60 0.00
10 MINIMUM TAX PAYABLE 70 0.00
11 COA RENEWAL FEE 80 0.00
12 ANN. STATEMENT FILING FEE 90 0.00
13 TOTAL AMOUNT REMITTED 0.00

Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge, believe it to be true and complete.

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