| 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 |