Form Dexm - Domestic Companies Annual Report - 2006 Page 4
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5DEXM (10-06)
Page 4
SCHEDULE C----CALCULATION OF GUARANTY FUND ASSESSMENT CREDIT
Eligibility-Provided for by the New Jersey Life and Health Insurance Guaranty Association Act (N.J.S.A. 17B:32A-18),
a member Life and Health insurer may offset against its premium tax liability, attributable to premiums written in that
year, any assessments for which a certificate of contribution has been issued, to the extent of 10% of the amount of
those assessments for each of the five calendar years following the second year after the year in which those
assessment were paid, except that no member insurer may offset its premium tax liability by more than 20% of its
tax liability in any one year.
Be sure to include proof of payment for all assessments listed below.
YEARS IN WHICH A CREDIT FOR AN
MAXIMUM
YEAR
ASSESSMENT CAN BE CLAIMED
AMOUNT
ALLOWABLE CREDIT
ASSESSMENT
(CREDIT IS 10% OF ASSESSMENT)
OF
10% OF
PAID
1
2
3
4
5
6
7
ASSESSMENT
ASSESSMENT
1999
XX
XX
2002 2003 2004 2005 2006
1.
2000
XX
XX
2003 2004 2005 2006 2007
2.
2001
XX
XX
2004 2005 2006 2007 2008
3.
2002
XX
XX
2005 2006 2007 2008 2009
4.
2003
XX
XX
2006 2007 2008 2009 2010
5.
Maximum Credit Available for this Return (add lines 1 through 5 above)
6.
Enter 20% of the tax liability reported on Schedule A, Line 18
7.
Enter the lesser of line 6 or 7 here and on Schedule A, Line 21
8.
DOMESTIC COMPANIES
GENERAL FILING INSTRUCTIONS
Please note that material changes have been made to the tax form due to computerization of Department of
Banking and Insurance and Division of Taxation records. Listed below you will find instructions which highlight
special areas of concern when completing the tax return.
1. NAIC code—At the top left side of the first page of the return is a space to provide the insurer’s five digit NAIC
(National Association of Insurance Commissioners) code. This space must be completed by all taxpayers.
2. Peel Off Labels—Will no longer be provided.
3. Schedule A—Please note that Schedule A, including lines 1 to 14, must be completed by all taxpayers, even if the
taxpayer is calculating the tax based on the 12.5% limitation indicated in Schedule B.
4. Penalty and Interest—Any taxpayer which shall fail to file its return when due or fail to pay any tax when due
shall be subject to penalties and interest as provided for in the State Tax Uniform Procedure Law
N.J.S.A. 54:48-1 et seq. and N.J.S.A. 18:2-2.1 et seq.
5. Please note that attachments must be included with the return being filed with the Division of Taxation and with the
duplicate original return which is simultaneously being filed with the Department of Banking and Insurance.
INSTRUCTIONS FOR THE DETERMINATION OF TAXABLE
PREMIUMS AS PROVIDED IN N.J.S.A. 54:18A-6
(SCHEDULE B)
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is not greater than the
amount indicated at Section I, Line 4, Column B, then the company does not qualify to use this limitation. Taxable Premiums are then those
included at Line 14 of Schedule A.
If the company was licensed subsequent to 6/30/84 and the amount indicated at Section I, Line 4, Column C is greater than the amount
indicated at Section I, Line 4, Column B, then taxable premiums are the amounts indicated at Section II, Column B. These amounts should be
entered at the applicable Line(s) (15, 16, 17) of Schedule A. A detailed schedule of Worldwide and New Jersey Premiums of the Company
and each affiliate must also be submitted with this schedule.
If the company was licensed prior to 7/1/84 and if the amount indicated at Section II, Line 4, Column B is less than taxable premiums
indicated at Line 14 of Schedule A, then enter amounts from Column B at the applicable Line(s) (15, 16, 17) of Schedule A. If the amount
indicated at Section II, Line 4, Column B is not less than taxable premiums indicated at Line 14 of Schedule A, then taxable premiums are
those included at Line 14 of Schedule A.
SMART MOVES FOR BUSINESS PROGRAM TAX CREDIT
A taxpayer who has registered with the New Jersey Department of Transportation and who has an authorized report/plan to provide
commuter transportation benefits may claim a tax credit based on the direct expenditures attributed to the plan.
To claim the credit the taxpayer must complete Form 307 and attach it to the tax return. This form and related information may be
obtained from the Taxpayer Forms Service, PO Box 269, Trenton, N.J. 08695-0269, by calling 1-800-323-4400 for New Jersey taxpayers or
609-826-4400 for out-of-state taxpayers, or by accessing the Division of Taxation’s website at
If Form 307 is being submitted, the appropriate tax liability to be reported on line 13 of Part III is the tax amount reported on line 18,
Schedule A of this premium tax return. The tax credit amount to be reported on Line 18, Part III of Form 307 is the amount reported on Line
21, Schedule A of this return.
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