Get 2009 Supplement Form.doc. Image - In

Filling out the 2009 Supplement Form is a crucial process for reporting premium deductions and company information in accordance with Indiana regulations. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to successfully complete the 2009 Supplement Form.

1. Press the ‘Get Form’ button to access the supplement form and open it in your preferred online editor.
2. Begin by filling in the company information section, which includes the NAIC number, company name, and both the main and billing addresses if they differ.
3. Next, move to the Indiana premium deductions section. Here, report the premium deductions based on various insurance types as specified in the form.
4. For each type of premium deduction listed, include the respective dollar amounts in the provided fields from (A) through (J). Ensure that you sum these amounts clearly and correctly in the total deductions field.
5. In the signature of officer section, ensure that an authorized individual signs the form, providing their printed name, title, and the date.
6. Finally, prepare the completed form for submission by ensuring all sections are filled out accurately, and include any required documentation, such as the referenced Indiana State Page.
7. After reviewing the form, save your changes, then download, print, or share the form as necessary, ensuring it is sent via traceable mail as instructed.

Complete your 2009 Supplement Form online today for accurate and timely submission.