Form 480.40f - Foreign Life Insurance Company Income Tax Return Page 3

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Foreign Life Insurance Company - Page 3
Form 480.40F Rev. 09.99
Part VI
Questionnaire
Yes
No
Yes No
1.
Did the corporation keep any part of its accounting tax
(b) Living expenses? .....................................................
(7b)
records on a computerized system during this taxable year?
(c) Employees attending conventions or meetings outside
(1)
2.
The corporation's books are in care of:
Puerto Rico or the United States? ................................
(7c)
Name
8.
Did the corporation distribute dividends (other than stock
Address
or liquidation dividends) in excess of the corporation's
current and accumulated earnings during this taxable year?
(8)
3.
Check method of accounting:
9.
Is the corporation a partner in any special partnership?
(9)
>
>
Cash
Accrual
Name of the Special Partnership___________________
>
Other (specify):______________________________
_____________________________________________
4.
Did the corporation file the following documents?:
Employer's identification number ___________________
(a) Informative Return (Forms 480.5, 480.6A, 480.6B).......
10.
Is the corporation a member of a controlled group?......
(4a)
(10)
(b) Withholding Statement (Form 499R-2/W-2PR).............
11.
Enter the amount of exempt interest: _______________
(4b)
5.
If the gross income exceeds $1,000,000, are financial
12.
Did the corporation make a qualified charitable
statements audited by a CPA licensed in Puerto Rico
contribution to municipalities? .......................................
(12)
included with this return?....................................................
13.
Indicate if insurance premiums were paid by an
(5)
6.
Number of employees during the year: ______________
unauthorized insurer......................................................
(13)
7.
Did the corporation claim a deduction for expenses
14.
Indicate the employer number assigned by the Department
connected with:
of Labor and Human Resources: ___________________
(a) Vessels? .......................................................................
15.
Number of stockholders:
____________________________
(7a)
OATH
We, the undersigned, president (or vice president, or other principal officer) and treasurer (or assistant treasurer), or agent of the corporation for
which this income tax return is made, each for himself declare under penalty of perjury, that this return (including schedules and statements
attached) has been examined by us and is, to the best of our knowledge and belief, a true, correct, and complete return, made in good faith,
pursuant to the Puerto Rico Internal Revenue Code of 1994, as amended, and the Regulations thereunder.
_____________________________________________________
_____________________________________________________
Treasurer's or assistant treasurer's signature
President's or vice president's signature
__________________________________________________
Agent
Affidavit No. _________________________
NOTARY
SEAL
Sworn and subscribed before me by ____________________________________________________________, of legal age,
______________________ [civil status], ______________________________ [occupation], and resident of ________________,
____________________________, and by ________________________________, of legal age, ______________________
[civil status], ______________________________ [occupation], and resident of __________________, __________________,
personally known to me or identified by means of _________________, at _________, _________, this ___ day of __________, ______.
Title of the person administering oath
Signature of the person administering oath
Specialist's Use Only
I declare under penalty of perjury that this return (including schedules and statements attached) has been examined by me, and to the
best of my knowledge and belief is a true, correct and complete return. The declaration of the person that prepares this return is with
respect to the information received, and this information may be verified.
Specialist's name (Print letter)
Registration number
Date
Check if
Specialist's social security number
>
self-employed
Firm's name
Employer's identification number
Specialist's signature
Address
Zip code

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