Form E-Rg - Foreign Risk Retention Group Annual Tax Report Page 3
Download a blank fillable Form E-Rg - Foreign Risk Retention Group Annual Tax Report in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form E-Rg - Foreign Risk Retention Group Annual Tax Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7COMPANY NAME:
State Of Incorporation:
NAIC#:
YEAR:
SCHEDULE AVP
ARIZONA VEHICLE PREMIUMS
You must file this Schedule to report premiums and all other amounts including finance or service charges,
Arizona Automobile Theft Authority Fees charged to insureds, policy fees and any other considerations received
from all insurance carried for or on vehicles for the calculation of “Additional Vehicle Tax”. Do not include auto
warranty premiums.
This tax is IN ADDITION TO the 2% tax for all property and casualty insurance business.
You must determine the portions of vehicle premiums for lines 3, 4, 5.1, 9 and 34, as well as the amount to be
reported on Line B (see Note below).
LINES 19.1 THROUGH 21.2 MUST EQUAL THE PREMIUM REPORTED ON THE SAME LINE OF YOUR
ANNUAL STATEMENT ARIZONA STATE PAGE
Please enter “0” where applicable
DIVIDENDS ON
VEHICLE
STATE
ARIZONA
PREMIUMS
PAGE
VEHICLE
(Only if included in
LINES OF BUSINESS
LINE #
PREMIUMS
Column 1
premiums)
(1)
(2)
3.
Farm owners multiple peril (vehicle portion)
$
$
4.
Homeowners multiple peril (vehicle portion)
$
$
5.1
Commercial multiple peril – Non-Liability (vehicle
$
$
9.
Inland marine (vehicle portion)
$
$
19.1
Private passenger auto no-fault (personal injury
$
$
)
19.2
Other private passenger auto liability
$
$
19.3
Commercial auto no-fault (personal injury protection)
$
$
19.4
Other commercial auto liability
$
$
21.1
Private passenger auto physical damage
$
$
21.2
Commercial auto physical damage
$
$
$
$
34.
Other (specify):
0.00
0.00
$
A
Total Premiums and Dividends
B
Fees, Finance & Service Charges not included in
$
VEX
amounts above. SEE NOTE BELOW.
$
C
Sum of A and B, Column 1 only
0.00
VE Gross
0.00
D
Total Dividends
(-) $
VED
E
Other Deduction – Describe:
(-)
VUP?
0.00
F
Taxable Premiums
$
VE Tax
G
Tax Rate
0.4312%
$
H
Additional Vehicle Tax Due
0.00
VT
NOTE: If line B is less than the total Finance and Service Charges reported separately in the Arizona State
Page of your Annual Statement, identify the other lines of business to which they apply: ___________________
E-RG (11/09)
Arizona Department of Insurance
Page 3 of 7
Goto Page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial