Form E-Ii - Industrial Insureds Premium Receipts Report - 2015
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5Insurance Tax Section
INDUSTRIAL INSURED PREMIUM
Arizona Department of Insurance
RECEIPTS TAX REPORT
2910 North 44th Street, Suite 210
(ARS § 20-401.07)
Phoenix, AZ 85018-7269
Phone: (602) 364-3997
Web:
https://insurance.az.gov
INSTRUCTIONS FOR FORM E-II
WHO MUST FILE FORM E-II?
This report must include each insurance policy you procured from an unauthorized insurer for
which Arizona is your "home state." Arizona is your home state when any of the following
three situations applies:
1.
Your principal place of business is in Arizona AND at least some of the property or risk
covered by the insurance you procured is located in Arizona.
2.
Your principal place of business is outside Arizona AND none of the property or risk
covered by the insurance you procured is located in the state where your principal place
of business is located AND Arizona is where the greatest percentage of your taxable
premium is allocated for the insurance contact.
3.
You are reporting on behalf of an affiliated group of insureds named on a single
insurance contract procured from an unauthorized insurer and the member of the
affiliated group with the largest percentage of premium attributed to it under the
insurance contract has its principal place of business in Arizona.
If none of the foregoing situations apply to any of the insurance policies you procured,
do not file a report or pay a tax to Arizona.
HOW IS THE TAX CALCULATED?
For each insurance policy for which Arizona is your home state, you must pay the 3% tax on
ALL (100%) of the premium, regardless of the portion of the premium that applies to risk or
property within Arizona. For informational purposes only, Form E-II asks you to report the
percentage of premium allocable to property/risk located in Arizona.
WHERE DO I SEND MY COMPLETED REPORT AND TAX PAYMENT?
INSURANCE TAX SECTION
Arizona Department of Insurance
2910 North 44th Street, Suite 210
Phoenix, AZ 85018-7269
WHEN IS THE COMPLETED REPORT AND TAX PAYMENT DUE?
February 15, 2015 for Arizona-only transactions effective July 1 through December 31;
AND, for multi-state transactions effective October 1 through December 31.
SEMI-ANNUALLY AFTER THE FEBRUARY 15, 2015 due date:
August 15 for all transactions effective January 1 through June 30
February 15 for all transactions effective July 1 through December 31
When submitting your tax report, please do not submit this instruction page.
Page 1 of 5
Industrial Insureds Premium Receipts Report
Form E-II (v20150224)
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