Independent Procurement Forms

 

Listed below are URL addresses which will direct an insured to independent procurement forms from various state departments of insurance/state stamping offices. The insured should complete and send these forms, along with any resulting payment, directly to the applicable state(s). Please note that these tax forms are for the insured's usage only, and are being provided to the insured for convenience purposes only. In providing access to these forms, Aon is not advocating or advising whether independent procurement tax is due or not. The insured should consult its tax advisor in order to decide whether any applicable tax is due for such self-procured policies.
 

Alabama http://www.aldoi.gov/Companies/ProcuredTaxReturn.aspx 
Alaska Consumer Tools (alaska.gov)
Arizona http://www.id.state.az.us/taxunit/index.html#SLBAL 
Arkansas http://www.insurance.arkansas.gov/PandC/P&CForms/self_procuredform.pdf 
California https://www.ftb.ca.gov/forms/2016/16_570.pdf 
Colorado http://coloradoc2.migrate.acquia.com/pacific/dora/node/95031
Connecticut form-115-nin_0921.pdf (ct.gov)
Delaware

Self-Procured-24-Paper.pdf (delaware.gov)

District of Columbia No IP forms available
Florida https://www.fslso.com/licensing-registration/ipc-registration
Georgia https://www.oci.ga.gov/PremiumTax/Home.aspx
https://gims.oci.ga.gov/gims/s/
Hawaii http://cca.hawaii.gov/ins/surplus-lines-tax/ 
Idaho https://doi.idaho.gov/wp-content/uploads/2023/12/2024-Instructions_IndepProcured.pdf
(Click on 'Independently Procured Tax Report & Instructions')
Illinois https://www.slai.org/info/info_ipfile.asp
https://www.slai.org/ipfile/login.asp
Bottom link direct to the filing system
Indiana No IPT
Iowa https://iid.iowa.gov/premium-tax-filing-instructions-surplus-lines-producers-and-purchasing-groups
https://content.naic.org/industry/optins
Kansas No IPT
Kentucky http://revenue.ky.gov/forms/cuyrfrms.htm
(Click on 'Unauthorized Insurance Tax Return')
Louisiana http://www.ldi.state.la.us/docs/default-source/documents/financialsolvency/Surplus-Lines/form-1265b-self-procured.pdf
Maine https://www.maine.gov/revenue/taxes/income-estate-tax/insurance-taxes
Maryland https://insurance.maryland.gov/Producer/Documents/independprocurredinsfilinginstructions.doc
Massachusetts No IPT
Michigan https://www.michigan.gov/-/media/Project/Websites/difs/Form/Insurance/Purchasing_Group/FIS_0255.pdf?rev=9d9aceff742848208eaaeb0100e25cf3
Minnesota Direct Procured Insurance Tax | Minnesota Department of Revenue (state.mn.us)
Mississippi http://www.mid.ms.gov/companies/pdf/independentlyprocured.pdf
Missouri Self-Procured Insurance Tax Report - Appendix 4 (mo.gov)
Montana Independently Procured Form is available by [email protected]
Nebraska Nebraska does not permit Independent Procurement
Nevada https://tax.nv.gov/wp-content/uploads/2024/03/EXC-F063-Independently-Procured-Insurance-Form2.pdf
New Hampshire https://mm.nh.gov/files/uploads/nhid/documents/ind-procured.pdf
New Jersey SLIP Resource Center
(web file online)
New Mexico http://www.osi.state.nm.us/FinancialAudit/index.aspx
(Under "Forms & Information" click on "Self Procured (Form 308)")
New York Form:
Form CT-33-D:8/15:Tax on Premiums Paid or Payable To an Unauthorized Insurer For Taxable Insurance Contracts with an Effective Date on or after July 21, 2011:ct33d (ny.gov)
Instructions:
Form CT-33-D-I:8/16:Instructions for Form CT-33-D Tax on Premiums Paid or Payable To an Unauthorized Insurer For Taxable Insurance Contracts with an Effective Date on or after July 21, 2011:ct33di (ny.gov)
North Carolina https://www.ncdoi.gov/documents/property-and-casualty/form-f-independent-procurement-12-01-04/open
North Dakota No IP forms available
Ohio  https://dam.assets.ohio.gov/image/upload/insurance.ohio.gov/Forms/Documents/INS4023.pdf 
Oklahoma https://www.oid.ok.gov/bulletin-no-12-2023/
Oregon [email protected]
Pennsylvania https://www.revenue.pa.gov/FormsandPublications/FormsforBusinesses/CorporationTax/Documents/rct-122.pdf
(Click on Form RCT-122)
Rhode Island http://www.tax.ri.gov/taxforms/otherbusiness.php
(Under the list of forms, click on “T-71SP - 2017 Self Procurement Insurance Premiums Return”)
South Carolina No IP forms available
South Dakota http://www.state.sd.us/drr2/reg/insurance/companies/surpluslines.htm 
(Click on 'Self-Procurement Affidavit')
Tennessee https://www.tn.gov/content/dam/tn/commerce/documents/insurance/posts/Industrial_Insured_Self_Procurement_Filing_Procedures.pdf 
Texas Texas Insurance Tax Forms
Utah Directly Placed
Vermont http://www.bishca.state.vt.us/sites/default/fi les/VTDirectInsurancePlacementReportingForm.pdf 
Virginia No IP forms available
Washington Washington does not permit Independent Procurement
West Virginia No IP forms available
Wisconsin https://oci.wi.gov/Pages/Companies/SpecialReportingForm.aspx
Second link is direct to the form
Wyoming No IP forms available