This form is specifically for Fraternal Benefit Societies, and reflects that although Fraternals are exempt from paying premium taxes to the State of Delaware (18 Del. C., '6224), the companies are assessed an Annual Statement filing fee and Certificate of Authority annual continuation fee as indicated on the form (18 Del. C., '701).  In addition, some foreign Fraternals may be subject to retaliatory tax based on their home states taxes and fees as compared to Delawares (18 Del. C., '532).

Although they are not assessed premium tax on gross premiums, Fraternals are required to report premium information for all direct business written in the State of Delaware during the calendar year.  If no premium was written in Delaware during the calendar year, a zero report must be filed.  Please follow all instructions as indicated on the form.