Form 63-29a - Ocean Marine Profits Tax Return (Page 4 of 6) in pdf

Form 63-29a - Ocean Marine Profits Tax Return Page 4

2016 FORM 63-29A, PAGE 4

Name of company

Federal Identification number

Supplementary schedule

b. Foreign —

c. Business within

all classes line 40(c)

United States

Entire business

ocean marine and

all classes

45(d) all others

subtract col. b from col. a

Premiums written

11 Direct (net of refunded) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

12 Reinsurance assumed (net of returned) . . . . . . . . . . . . . . . . . . . . . . 2

13 Total. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

14 Deduct: reinsurance premiums ceded. . . . . . . . . . . . . . . . . . . . . . . . 4

c ________ d ________

15 Net premiums retained. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Losses paid

16 On direct writings (salvage deducted) . . . . . . . . . . . . . . . . . . . . . . . . 6

17 On reinsurance assumed (salvage deducted). . . . . . . . . . . . . . . . . . 7

18 Total. Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

19 Deduct: reinsurance recoveries ceded . . . . . . . . . . . . . . . . . . . . . . . 9

c ________ d ________

10 Net losses paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Ocean marine expenses.

Col. a should agree with corresponding lines in Insurance Expense Exhibit.

– Paid –

– Incurred –

a. Total ocean

b. Foreign ocean

c. Foreign ocean

marine business

11 Loss adjustment expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Commission and brokerage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Other acquisition, field supervision and collection expenses . . . . . 13

14 General expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Taxes, licenses and fees excluding federal income and real

estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Form 63-29a - Ocean Marine Profits Tax Return Page 4