Nebraska Department of Insurance
NORTH DAKOTA AND NEW HAMPSHIRE PREMIUM TAX FORMS
These forms are to be used only if your company is domiciled in North Dakota or New Hampshire.
Please choose your company's line of insurance from the following list. Each form is a seperate file and must be downloaded seperately. If you do not find your line of insurance, please contact Martha Hettenbaugh at 402-471-2201.
Property and Casualty Insurer
- This packet contains the following forms:
Life and Health Insurer
- This packet contains the following forms:
- State Filing Checklist and Instructions
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Nebraska Small Employer Health Reinsurance Program (NSEHRP)
- Comprehensive Health Insurance Pool (CHIP)
- Request for Fraud Contact and Suspected Fraudulent Claim Report
Health Maintenance Organization
- This packet contains the following forms:
- State Filing Checklist and Instructions
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Nebraska Small Employer Health Reinsurance Program (NSEHRP)
- Comprehensive Health Insurance Pool (CHIP)
- Request for Fraud Contact and Suspected Fraudulent Claim Report
Title Company
- This packet contains the following forms:
Risk Retention Group
- This packet contains the following forms:
- State Filing Checklist and Instructions are not available for Risk Retention Groups
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Request for Fraud Contact and Suspected Fraudulent Claim Report