Form In 0578 - Companies Other Than Life - State Of Tennessee The Department Of Commerce And Insurance Page 2
ADVERTISEMENT
1
2
3Schedule B – COMPUTATION OF FIRE MARSHAL TAX
(To Be Computed By Property Insurers Only)
PERCENTAGE
DIRECT
FIRE
TO BE
LINE OF BUSINESS
PREMIUMS
PORTION
APPLIED
Fire Lines
$
100%
$
Farm Owners Multiple Peril
$
$
55%
Homeowners Multiple Peril
$
55%
$
Commercial Multiple Peril (non-liability portion & liability portion)
$
$
50%
Inland Marine
$
20%
$
Private Passenger Auto Physical Damage
$
$
8%
Commercial Auto Physical Damage
$
8%
$
Aircraft (All Perils)
$
$
8%
Industrial Fire
$
100%
$
Other
$
$
$
Fire Portion Subject to Fire Marshal Tax (Sum of the above fire portion lines)
Apply ¾ of 1%
0.0075
X
FIRE MARSHAL TAX
$
ENTER THIS AMOUNT
Do not list negative amounts on any of the above lines; if negative, enter zero (0)
ON LINE 3 pg 1
Schedule E – WORKMEN'S COMPENSATION INSURANCE SURCHARGE
(To Be Completed By All Companies Writing Workmen’s Compensation Insurance)
Complete steps 1 thru 5. If Company did not write any Workmen’s Compensation premiums during prior calendar quarter,
please indicate as “NONE” on Line 1 of this Schedule.
1. Gross Workmen's Compensation Premiums as listed on Line 2, Page 1
$
*2. Subtract Premiums not subject to Surcharge (see note below)
$
3. Premiums subject to Workmen’s Compensation Surcharge
$
4. Apply four-tenths of one percent (0.4%) rate to amount on line 3
0.004
X
5. WORKMEN’S COMPENSATION SURCHARGE
$
ENTER THIS AMOUNT ON
Do not list a negative Surcharge amount on line 5; if negative, enter zero (0)
LINE 4, PAGE 1.
NOTES
*The Surcharge of four-tenths of one percent (0.4%) on Workmen’s Compensation Insurance shall not apply to any premiums written on or for an
employer who employs ten (10) or less employees unless such employer is in the business of construction or manufacturing.
Explain in detail the method used in calculating any reduction of Workmen’s Compensation Surcharge premiums which are not subject to the
Surcharge tax in the space below:
IN-0578
Other Than Life Quarterly Tax Form Rev 3/2014
Page 2 of 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Sl 3 - Surplus Lines Statement Of Premiums And Tax Payment - Department Of Commerce And Insurance
Legal
Form In-0578 - Statement Of Premiums And Fees For Taxation - Companies Other Than Life - Tennessee Department Of Commerce And Insurance - 2002
Financial
Form In-0581 - Life And Accident And Health Companies - Tennessee Department Of Commerce And Insurance
Legal
Related Categories
Parent category: Legal