Surplus Lines Zero Pay

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

NPN NAIC

Tax Year: - yyyy

Quarter:

1st

2nd

3rd

NPN#

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.

: I AGREE