Form 303 - Premium Tax Final For Vehicle Insurance Companies - 2011
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1PREMIUM TAX FINAL FOR VEHICLE INSURANCE COMPANIES
For calendar year ending December 31, 2011.Original to be filed with the Superintendent of Insurance Santa Fe, New Mexico,
no later than April 15, 2012.
PLEASE FILL OUT THE FOLLOWING:
Company Name: ________________________________________________________
Company Co. # _______
Company Address: ______________________________________________________
Class:
__________
______________________________________________________
NAIC:
__________
Contact: _____________________________________________
Phone/Email:_________________________________________
DEDUCTIONS ALLLOWED
1.
2.
3.
4.
5.
6.
Gross Premiums
Return
Political
Dividends
Premiums
Net Premiums on
received from
premiums
Subdivisions
paid/credited
received from
which the New
policies within the
to
Authorized
Mexico tax is
CLASS
State of New
policyholders
companies
based
Mexico
for
(Column 1 minus
reinsurance
2, 3, 4 & 5).
on NM risks.
(19.1) Pvt. Passengers Auto
No Fault
(19.2) Other Pvt. Passenger
Auto Liability
(19.3) Commercial Auto No
Fault
(19.4) Other Commercial Auto
Liability
(21.1) Pvt. Passenger Auto-
Physical Damage
(21.2) Commercial Auto-
Physical Damage
(22) Aircraft (All Perils)
Miscellaneous
1.TOTALS
2. Premium Tax Due (3.003% of line 1)
st
nd
3. Less 1
and 2
quarterly taxes paid (include credit taken)
rd
th
4. Less 3
and 4
quarterly taxes paid (include credit taken)
5. Less year 2011 remaining credit not used in line 36 & 37
6.Net Premium Taxes Due
#78
Total Amount of Check
Check #
The insurance company above named; whose return for PREMIUM TAX is herein above set forth; that they signed the forgoing
Premium Tax returns for and as of the act of said insurance company by authority of its Board of Directors that they have examined
the contents thereof; and that to their best knowledge and belief are true and correct, as disclosed the books of said insurance
company as of December 31, 2011.
NOTARY SEAL
____________________________
President
Notary Signature _____________________
My Commission Expires _______________
_____________________________
Secretary/Treasurer
Subscribed and sworn before me this _____ day of _______, 20___
Form 303
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