2021 Premium Tax Forms and Instructions

Premium Tax Forms are now available in MS-Excel (MS-Excel) format. Instructions, and Information are in Microsoft-Word format (MS-Word). Each may be downloaded to your computer. If your current software does not support these formats, you may download the Web App by visiting our Free Document Readers page.

1. Contact our Premium Tax Audit Unit if you need Assistance completing or reading these forms.
2. Contact our EFT Unit if you need assistance on making tax payments.
3. For filing an Original Tax Return, a scanned copy of the physically signed Premium Tax Return can be filed via e-mail to PremiumTaxFiling@insurance.ca.gov. For filing an Amended Tax Return, please follow the Tax Return Instructions on how and where to file.
4. If tax payments are made via EFT, Tax Payment Vouchers can be filed via e-mail to PremiumTaxFiling@insurance.ca.gov.
5. When filing via e-mail, include in the subject line: the Name of the insurer or surplus line broker; the insurer's CA Permanent number or surplus line broker's CA license number; and the Tax year of the tax form being filed.

Calendar Year 2021 Tax Forms, Instructions, and Information

All Classes | Home | Life Companies | Ocean Marine | Pre-Payment | Surplus/Special Lines | Title

All Classes - Except Ocean Marine, Life, Title, And Home Protection

All Classes of Insurance Tax Return Form - Except Ocean Marine, Life, Title, And Home Protection
(CDI FS-001 MS-Excel) Revised 11/2021

All Classes of Insurance Tax Return Instructions (Except Ocean Marine, Life, Title, And Home Protection)
(MS-Word) Revised 12/2021

Bulletin 137 - Premium or Undertaking of Bail

(MS-Word)

Life Companies - Including Accident and Health Insurance

Life Companies Tax Return Form
(CDI FS-002 MS-Excel) Revised 11/2021

Life Companies Tax Return Instructions
(MS-Word) Revised 11/2021

Life Companies Tax Return Attachment A
(MS-Word)

Life Companies Tax Return Attachment B
(MS-Word)

Title Insurance

Title Insurance Tax Return Form
(CDI FS-003 MS-Excel) Revised 11/2021

Title Insurance Tax Return Instructions
(MS-Word) Revised 11/2021

Home Protection

Home Protection Tax Return Form
(CDI FS-004 MS-Excel) Revised 11/2021

Home Protection Tax Return Instructions
(MS-Word) Revised 11/2021

Ocean Marine

Ocean Marine Insurance Tax Return Form
(CDI FS-005 MS-Excel) Revised 11/2021

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Surplus Lines - Special Lines

Surplus Line Broker and Special Lines Surplus Line Broker Tax Return Form
(CDI FS-006 MS-Excel) Revised 11/2021

Surplus Line Broker and Special Lines Surplus Line Broker Tax Return Instructions
(MS-Word) Revised 11/2021

Surplus Line Broker and Special Lines Surplus Line Broker Tax Calendar
(MS-Excel) Revised 11/2021

Zero Tax Return Surplus Line Broker and Special Lines Surplus Line Broker Form
(CDI FS-006-0 MS-Excel) Revised 11/2021

Zero Tax Return Surplus Line Broker and Special Lines Surplus Line Broker Form Instructions
(MS-Word) Revised 11/2021

Surplus Line Broker's Monthly Tax Payment Voucher Form

(CDI FS-007 MS-Excel) Revised 11/2021

Tax Pre-Payment Voucher  & EFT

Premium Tax Voucher for the 1st Quarter Prepayment Form

(CIA-T-4 MS-Excel) Revised 11/2021

Premium Tax Voucher for the Quarterly Prepayment Form
(CIA-T-4A MS-Excel) Revised 11/2021

Electronic Funds Transfer Program Information Guide for Tax Payments

(PDF) Revised 11/2021

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