Fillable Form SL- 10 - the State of Connecticut Website

Description
FORM SL-10 CONNECTICUT PREMIUMS BY BROKER Period 20 to 20 NAME OF COMPANY CONTACT PERSON ADDRESS PHONE NAME & ADDRESS BROKER (A) INSURED NAME (B) DIRECT PREMIUM (C) RETURN PREMIUM (D) DIRECT PREMIUM LESS RETURN PREMIUM (E) TOTAL INSTRUCTIONS - SL-10 1. 2. 3. INDICATE REPORTING PERIOD DATES FILL OUT FULL NAME OF COMPANY INDICATE THE NAME AND ADDRESS OF A PERSON WHO MAY BE CONTACTED WITH REFERENCE TO SUCH...
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