FOREGN/ALIEN COMPANIES SHOULD ONLY FILE THOSE SPECIFIC ITEMS NOTED AS REQUIRED IN THE FOREIGN COLUMN. PLEASE DO NOT FILE ITEMS NOT SPECIFICALLY REQUIRED. (5) Due Date Indicates the date on which the company must file the form. See Note E. (6) Form means the company must obtain the form from the appropriate vendor. See Note M. “NAIC” Source means that Pennsylvania will provide the forms upon request. “State” means that the company, or its representative (e.g., its CPA firm), must provide the form based “Company” upon the appropriate state instructions or the NAIC Annual Statement Instructions. (7) Notes The letters in this column correspond to the notes contained in the Please read “Notes Pennsylvania” section. each applicable note carefully before submitting a filing. NOTES PENNSYLVANIA Notes A to L apply to filings. A Required Filings Life Companies Contact Person Financial Analysis Division Phone: 717.783.2142 E-Mail: B Mailing Address State: NAIC: Life Insurance Companies Financial Analysis Division NAIC Data Base Pennsylvania Insurance Department 1100 Walnut Street, Suite 1500 1345 Strawberry Square Kansas City, MO 64106-2197 Harrisburg, PA 17120 Phone: 816.783.8600 C Filing Fees IMPORTANT: YOU WILL RECEIVE AN INVOICE IN EARLY APRIL FOR APPLICABLE ANNUAL STATEMENT/LICENSE RENEWAL FEES. DO NOT REMIT PAYMENT PRIOR TO RECEIVING YOUR INVOICE. There is a $750 Annual Statement filing fee. The invoice for Foreign/Alien companies will include a $100 fee for the renewal of your Certificate of Authority. The Pennsylvania Insurance Department no longer mails renewal Certificates of Authority. Annual renewal invoices will contain instructions for on-line printing of the insurer’s renewed Certificate of Authority. To minimize returned checks, additional fees, and other problems, please take note of the following instructions: A check with an amount equal to multiple invoices will not be Submit one check per invoice. accepted and will be returned to the company. Return entire original invoice with payment. Send payment to the Revenue address listed on the invoice, not any of the addresses on this checklist. Make checks payable to the of “Commonwealth Pennsylvania.” Questions regarding the filing fees: Kim Rankin, Director Bureau of Company Licensing and Financial Analysis E-Mail: Phone at 717.783.6409 D Premium Tax Do not send premium tax filing to Pennsylvania Insurance Department. Payments Please see:
FOREGN/ALIEN COMPANIES SHOULD ONLY FILE THOSE SPECIFIC ITEMS NOTED AS REQUIRED IN THE FOREIGN COLUMN. PLEASE DO NOT FILE ITEMS NOT SPECIFICALLY REQUIRED. (5) Due Date Indicates the date on which the company must file the form. See Note E. (6) Form Source “NAIC” means the company must obtain the form from the appropriate vendor. See Note M. “State” means that Pennsylvania will provide the forms upon request. “Company” means that the company, or its representative (e.g., its CPA firm), must provide the form based upon the appropriate state instructions or the NAIC Annual Statement Instructions. (7) Notes The letters in this column correspond to the notes contained in the “Notes Pennsylvania” section. Please read each applicable note carefully before submitting a filing. NOTES PENNSYLVANIA Notes A to L apply to filings. A Required Filings Contact Person Life Companies Financial Analysis Division Phone: 717.783.2142 E-Mail: B Mailing Address State: NAIC: Life Insurance Companies Financial Analysis Division NAIC Data Base Pennsylvania Insurance Department 1100 Walnut Street, Suite 1500 1345 Strawberry Square Kansas City, MO 64106-2197 Harrisburg, PA 17120 Phone: 816.783.8600 C Filing Fees IMPORTANT: YOU WILL RECEIVE AN INVOICE IN EARLY APRIL FOR APPLICABLE ANNUAL STATEMENT/LICENSE RENEWAL FEES. DO NOT REMIT PAYMENT PRIOR TO RECEIVING YOUR INVOICE. There is a $750 Annual Statement filing fee. The invoice for Foreign/Alien companies will include a $100 fee for the renewal of your Certificate of Authority. The Pennsylvania Insurance Department no longer mails renewal Certificates of Authority. Annual renewal invoices will contain instructions for on-line printing of the insurer’s renewed Certificate of Authority. To minimize returned checks, additional fees, and other problems, please take note of the following instructions: Submit one check per invoice. A check with an amount equal to multiple invoices will not be accepted and will be returned to the company. Return entire original invoice with payment. Send payment to the Revenue address listed on the invoice, not any of the addresses on this checklist. Make checks payable to the “Commonwealth of Pennsylvania.” Questions regarding the filing fees: Kim Rankin, Director Bureau of Company Licensing and Financial Analysis E-Mail: Phone at 717.783.6409 D Premium Tax Payments Do not send premium tax filing to Pennsylvania Insurance Department. Please see: