E638A Statement of Availability or Declination from Authorized Insurers – Tax on Insurance Premiums under Part I of the Excise Tax Act

Fill out this form if you are an authorized insurer and you want to provide a statement of availability or declination about the tax on insurance Premiums.

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (e638a-fill-24e.pdf)

• Print and fill out by hand

  • Standard print PDF (e638a-24e.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities