Instructions For Filing The 2016 Form 802 The Virginia Surplus Lines Broker'S Annual Reconciliation Tax Report Page 2
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1
2
3interest for late payments at the federal underpayment
Line 7
Enter the total quarterly Insurance Premiums
rate established under Internal Revenue Code §
License Tax amount paid during the year.
6621, plus 2%. For the current daily interest rate,
Line 8
If Line 6 is greater than Line 7, subtract Line
contact the Department at (804) 367-8037.
7 from Line 6 and enter that amount on Line 8.
LINE INSTRUCTIONS
Line 9
If Line 7 is greater than Line 6, subtract Line
Taxpayer Information: Enter your name, mailing
6 from Line 7 and enter that amount on Line 9.
address,
Virginia
Insurance
Premiums
License
Line 10 Enter the Fee for Late Filing. Surplus Lines
Tax account number, and Virginia broker’s license
Brokers are subject to a $50 late filing fine for each
number in the spaces provided.
day that the report is late.
Check the box for all that apply: Check the
Line 11 Enter the amount of the Penalty for Late
appropriate box if you have an address change or
Payment. If you pay the tax owed after the due date,
are filing an amended report.
you will be subject to a penalty of 10% of the tax due
Line 1
Enter
the
gross
amount
of
all
amount on Line 8.
premiums, assessments, dues, and fees collected,
Line 12 Upon failure to pay the annual Insurance
received, or derived, or obligations taken from
Premiums
License Tax
due
with
the
annual
policies for insureds whose home state is Virginia.
reconciliation tax report, interest is assessed at the
Line 2
Enter the amount of premiums written for
rate of interest established pursuant to Va. Code §
additional insurance for insureds whose home state
58.1-15 for the period between the due date of the
is Virginia. Additional insurance generally results
annual report and the date of full payment.
from an insurance rider, rate adjustment, or an
Line 13 Add Lines 10, 11, and 12.
advance premium that is less than the actual premium
Line 14 If you owe tax on Line 8, add Line 8 and Line
coverage.
13. If you have an overpayment on Line 9 but Line 13
Line 3
Add Line 1 and Line 2.
is greater than Line 9, subtract Line 9 from Line 13.
Line 4
Enter the portion of premiums returned to
This is the total payment due. Enter the sum on Line
an insured whose home state is Virginia. Additional
14 and on the Virginia Insurance Premiums License
insurance generally results from an insurance rider,
Tax Surplus Lines Broker’s Annual Reconciliation Tax
rate adjustment, or an advance premium that is less
Report Voucher, Form 802V.
than the actual premium coverage.
Line 15 If you have an overpayment on Line 9 and
Line 5
Subtract Line 4 from Line 3.
Line 9 is greater than Line 13, subtract Line 13 from
Line 9. This is your refund. Enter the sum on Line 15.
Line 6
Enter the Insurance Premiums License Tax
Sign and date your report.
liability amount by multiplying the amount on Line 5 by
2.25%.
Page 2
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