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Get Nc K1 For Form D-403 2004. Nc K1 For Form D-403 2004

) Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) Federal Employer ID Number Mailing Address City State Name of Contact Person Phone Number Zip Code State of Domicile NAIC Number Fill in circle if applicable: Payment has been made through electronic funds transfer (EFT) Amended Return Date of Withdrawal if Company Surrendered Certiicate of Authority to do Business in NC During the Year Schedule A. Summary of Amount Due 1. Total 2013 Gross Premium Tax.

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