New York Form Ifb 1 PDF Details

The New York Form Ifb 1 is a document that business owners in the state of New York use to report their income and taxes. The form covers a variety of tax information, including corporate and personal income, as well as sales and payroll taxes. By submitting this form, business owners can ensure that they are meeting all applicable tax requirements in New York. The deadline for filing the New York Form Ifb 1 is generally at the end of April each year.

This page holds information about new york form ifb 1. It's definitely worth making the effort to read through this just before you start filling out your form.

Form NameNew York Form Ifb 1
Form Length1 pages
Fillable fields37
Avg. time to fill out7 min 39 sec
Other namesifb10811 nys dfs ifb 1 form

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NEW YORK, NY 10004


1). Information furnished by:__________________________

Address: _______________________________________


NAIC # _______________________________________

Previously submitted? Yes ____ Log # ___________ No_____


2)Brief statement of suspect transaction. Date of loss ___________ Amount of loss ____________ County_____

Type of loss: Auto___ No-Fault___ Medical___ Workers Comp. __ Fraudulent ID cards__ Other_____________

If Auto or No-Fault, was this policy application submitted via NYAIP? Y N


3)Identify parties to suspect transaction: Name(s) Address(es)

Additional information on suspect(s)

If Auto or Fraudulent cards give VIN # _________________________ Plate or License # ____________________

4) Identify your policy, claim or reference number under which the above transaction is recorded:

Claim # __________________________ Claim status_____________________________________________

Reference #_____________________________ Policy # _________________________ SIU #_______________

5)Name, title, address & telephone number of individual in your company who can provide detailed information:

NAME__________________________________________ TITLE _________________________________

ADDRESS __________________________________________________ TELEPHONE # _____________

6)Have you reported this transaction to any other law enforcement agency? Yes ____________ No____________

If yes, please furnish: Agency _________________________________________________________________

Address ___________________________________________________________________________________

Person contacted _________________________ Telephone #____________________Date of report _________

Continue on reverse or attach additional sheets as necessary.

Signed: _______________________________

Title: ________________________________

IFB-1 REV 8/11

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