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Holder Reporting
1. Holder Information
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ENTER HOLDER INFORMATION:
* Required field
Primary Holder Information section header
Primary Holder Information
Please enter the following information:
*
Holder Name
:
*
Holder Tax ID
:
*
Holder ID
:
*
Life Insurance Confirmation
:
*
Contact Name
:
*
Contact Phone Number
:
*
Phone Extension
:
*
Email Address
:
*
Email Address Confirmation
:
Report Information section header
Report Information
Please enter the following information:
*
Report Type
:
Annual
Audit
State Agency Reporting
Supplemental Report
*
Report Year
:
- Select an Option -
2019
2020
2021
2022
2023
2024
*
This is a Negative Report
:
Yes
No
*
Total Dollar Amount Remitted
:
*
Funds Remitted Via
:
ACH
Check
Online Payment
Submit
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