Insurance Duty Exemption Declaration Form
Please complete this form to declare your request for an insurance duty exemption. All information provided will be used solely for the purpose of processing your exemption request.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Company Name
Insurance Policy Number
*
Type of Insurance Policy
*
Please Select
Life Insurance
Health Insurance
Property Insurance
Vehicle Insurance
Other
Exemption Basis
*
Please Select
Non-taxable Policy
Government Exemption
Charitable Organization
Other Legal Basis
Please provide supporting details for your exemption request
*
Upload Supporting Documents (if any)
Upload a File
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of
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