Get DE SL-1925-A 2016-2021
H 1, 2017 DOI SLTax state.de.us Please note the underscore between DOI & SLTax THIS FORM MUST BE SUBMITTED BY ALL INDIVIDUAL SURPLUS LINES BROKERS EVEN IF NO BUSINESS WAS WRITTEN TAX DEPARTMENT MAILING ADDRESS AND COMPANY INFORMATION Individual Broker ID: Form SL-1925-A (DE License #) Individual Broker NPN: Agency ID: Individual Broker Name Agency Name Tax Contact Name Contact Email Address Tax Address City State Zipcode Mail this form and applicable payment to: Delaware Insurance Depa.
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