• Before You Begin
  • Complete Agency Form
  • Enter Payment Info
  • Review & Submit
  • Confirmation

About this form

This form is used to pay the user fee applicable to any foreign insurer or reinsurer wishing to enter into a closing agreement under Rev. Proc. 2003-78, 2003-2 C.B. 1029. The stated user fee is in accordance with Appendix A of Rev. Proc. 2003-1, or any successor procedure.

Accepted Payment Methods:

  • Bank account (ACH)

This is a secure service provided by United States Department of the Treasury. The information you will enter will remain private. Please review our privacy policy for more information.

Contact:
Qian Mei Cen
Phone:
(917) 421-8459