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Get Fillable Ohio Surplus Lines Affidavit Form

Surplus Lines Premium Tax Summary www.insurance.ohio.gov Please note: This form is now available at www.insurance.ohio.gov If no money is due, this form does not need to be filed. ON-LINE SYSTEM USER ID(S): SLTAX (The number(s) must match the number(s) used when reporting ALL business on-line to the Dept. of Insurance) Name: Business Address: City: State: Telephone: Fax: Zip: License #: Contact Person s E-Mail Address: Risk Purchasing Group Risk Retention Group Surplus Lines Brok.

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