Ocean Marine Tax Report Form - New Jersey Department Of Banking And Insurance Page 2
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1
2State of New Jersey
DEPARTMENT OF BANKING AND INSURANCE
PO BOX 325
TRENTON, NJ 08625-0325
____________________________________ (Enter calendar year referred to below as current calendar
st
year). This report is due on or before April 1
of each year from all insurers licensed to write ocean marine
business _______________________________________ ______________________________________
(NAME OF INSURER)
(STATE OF INCORPORATION)
Ocean Marine Insurance means wet marine and transportation Insurance as defined by the New Jersey
Insurance Statutes. Net premiums earned, net losses Incurred and expenses Incurred are as defined by the
Fire and Casualty Annual Statement blank and Insurance Expense Exhibit thereof.
OCEAN MARINE INSURANCE BUSINESS
CURRENT CALENDAR YEAR
Total
Written outside
Written within
United States
United States
(1)
(2)
(1)-(2)
(3)
1. Net premiums earned
2. Net losses Incurred
3. Expenses Incurred Col (3) shall not exceed
40% of line 9 Col (3)
4. Underwriting profit, current calendar year.
Line 1 minus lines 2 and 3
5. Underwriting profit, last preceding calendar year,
U.S. business
6. Underwriting profit, second preceding calendar year,
U.S. business
7. Total underwriting profit, preceding three calendar years,
U.S. business. Sum of lines 4, 5 and 6
8. Average annual underwriting profit, preceding three
Calendar years, U.S. business. 1/3 of line 7
CALENDAR YEARS
Second
Last
Current
Preceding
Preceding
Preceding
Three
(1)
(2)
(3)
(1)+(2)+(3)
(4)
9. Gross premiums less return premiums, ocean
marine Insur written within U.S.
10. Gross premiums less return premiums, Ocean
Marine Insurance, written in N.J.
11. Ratio of ocean marine premiums, N.J. to U.S.
Line 10 Col (4) divided by line 9 Col (4)
12. N.J. proportion, average annual underwriting profit,
Preceding three calendar years. Line 11 times line 8
13. Tax on New Jersey Ocean Marine Insurance underwriting profit.
5.25% of line 12
14. Additional tax to equal domicilary state basis.
Furnish details of computation. (if negative enter zero)
15. Total taxes and fees due, sum of lines 13 and 14
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