Form Dexm - Domestic Companies Annual Report - 2009 Page 3
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5DEXM (10-09)
Page 3
SCHEDULE B
LIFE INSURANCE COMPANIES
CALCULATION OF TAXABLE PREMIUMS AS PROVIDED IN N.J.S.A. 54:18A-6
INSTRUCTIONS
This schedule is to be completed only by those companies electing to calculate taxable premiums as provided in
N.J.S.A. 54:18A-6 (12 ½% Limitation).
If the company was licensed subsequent to 6/30/84, complete both Section I and Section II.
If the company was licensed prior to 7/1/84, complete only Section II.
Worldwide Premiums should be calculated in Section I and II in accordance with the provisions for calculating
New Jersey Taxable Premiums as indicated at Schedule A, Line 14.
When completing Section 1, attach a separate schedule listing each affiliate and applicable premiums used in
completing column A of Section 1.
Schedule A, Lines 1 to 14, must still be completed by ALL TAXPAYERS.
SECTION 1 – COMPLETE ONLY IF LICENSED SUBSEQUENT TO 6/30/84
WORLDWIDE PREMIUM DATA FOR COMPANY COMPLETING THIS RETURN
AND ALL OF ITS AFFILIATES AS DEFINED IN N.J.S.A. 17:27A-1 et seq.
( A )
( B )
( C )
WORLDWIDE
12 ½% OF AMOUNT
NEW JERSEY
WORLDWIDE PREMIUM DATA
PREMIUMS
IN COLUMN (A)
PREMIUMS
1.
Life Insurance Premiums of Company
and all of its Affiliates
2.
Individual Accident & Health Insurance
Premiums of Company and all of its Affiliates
3.
Group Accident & Health Insurance
Premiums of Company and all of its Affiliates
4.
TOTAL
SECTION II –
MUST BE COMPLETED BY ALL COMPANIES ELECTING TO CALCULATE TAXABLE PREMIUMS
AS PROVIDED IN N.J.S.A. 54:18A-6.
WORLDWIDE PREMIUM DATA FOR COMPANY COMPLETING THIS RETURN
( A )
( B )
WORLDWIDE PREMIUM DATA
WORLDWIDE
12 ½% OF AMOUNT
PREMIUMS
IN COLUMN (A)
1.
Life Insurance premiums
2.
Individual Accident & Health Insurance Premiums
3.
Group Accident & Health Insurance Premiums
4.
TOTAL
IN ORDER TO DETERMINE WHICH FIGURES SHOULD BE APPLIED AS TAXABLE PREMIUMS AT
NOTE:
LINE(S) 15,16 AND 17 OF SCHEDULE A, PLEASE REFER TO THE INSTRUCTIONS ON PAGE 4 FOR
THE DETERMINATION OF TAXABLE PREMIUMS AS PROVIDED IN N.J.S.A. 54:18A-6.
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