Form 480.40f - Foreign Life Insurance Company Income Tax Return Page 2
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1
2
3Foreign Life
Insurance Company
- Page 2
Form 480.40F
Rev. 02.17
Part III
Comparative Balance Sheet
Beginning of the Year
Ending of the Year
Assets
Total
Total
00
1.
Cash on hand and in banks ............................
00
(1)
(1)
00
00
2.
Accounts receivable ...................................
(2)
(2)
(
)
(
)
00
00
00
3.
Less: Reserve for bad debts .......................
00
(3)
(3)
00
4.
Inventories ................................................
00
(4)
(4)
00
5.
Other current assets .....................................
00
(5)
(5)
00
6.
Notes receivable .......................................
00
(6)
(6)
00
7.
Investments ..............................................
00
(7)
(7)
00
00
8.
Depreciable assets .....................................
(8)
(8)
(
)
(
)
00
00
00
9.
Less: Reserve for depreciation ....................
00
(9)
(9)
00
10.
Loans receivable of stockholders or related entities
00
(10)
(10)
00
11.
Land ........................................................
00
(11)
(11)
00
12.
Other long-term assets ..................................
00
(12)
(12)
00
13.
Total Assets ............................................
00
(13)
(13)
Liabilities and Stockholder's Equity
Liabilities
00
00
14.
Accounts payable ......................................
(14)
(14)
00
00
15.
Accrued expenses (not paid) ..........................
(15)
(15)
00
00
16.
Other current liabilities .................................
(16)
(16)
00
00
17.
Long-term notes payable ..................................
(17)
(17)
00
00
18.
Notes payable to stockholders or related entities
(18)
(18)
00
00
19.
Other long-term liabilities .................................
(19)
(19)
00
20.
Total Liabilities .......................................
00
(20)
(20)
Stockholder's Equity
21.
Capital stock
00
00
(a) Preferred stocks .......................................
(21a)
(21a)
00
00
(b) Common stocks ......................................
(21b)
(21b)
00
00
22.
Additional paid in capital .................................
(22)
(22)
00
00
23.
Home office account ......................................
(23)
(23)
00
00
24.
Reserve ......................................................
(24)
(24)
00
25.
Total Stockholder's Equity ..........................
00
(25)
(25)
00
26.
Total Liabilities and Stockholder's Equity ...........
00
(26)
(26)
Part IV
Reconciliation of Net Income (or Loss) per Books with Net Taxable Income (or Loss) per Return
1.
Net income (or loss) per books .......................
(1)
00
7.
Income recorded on books this year not included on this
2.
Income tax per books ....................................
(2)
00
return (Itemize, use schedule if necessary)
3.
Excess of capital losses over capital gains .........
(3)
00
(a) Exempt interest $__________________________
4.
Taxable income not recorded on books this year
(b) __________________________$______________
(Itemize, use schedule if necessary)
(c) __________________________$______________
(a) _______________________$______________
(d) __________________________$______________
(b) _______________________$______________
(e) __________________________$______________
(c) _______________________$______________
(f) __________________________$______________
(d) _______________________$______________
(g) __________________________$______________
(e) _______________________$______________
Total ..................................................................
00
(7)
(f) ______________________$_____________
8.
Deductions on this tax return not charged against book
Total ........................................................
(4)
00
5.
Expenses recorded on books this year not claimed
income this year (Itemize, use schedule if necessary)
on this return (Itemize, use schedule if necessary)
(a) Depreciation $______________________________
(a) Meal and entertainment (amount
(b) __________________________$______________
not deductible) $______________________
(c) __________________________$______________
(b) Depreciation $__________________________
(d) __________________________$______________
(c) Motor vehicles (in excess of the limit) $________
(e) __________________________$______________
______________________________________
(f) __________________________$______________
(d) Vessels, airships and property located outside
(g) __________________________$______________
of P.R. $___________________________
(h) __________________________$______________
(e) Expenses incurred or paid to stockholders,
(i) __________________________$______________
related entities or persons $_________________
00
Total ..................................................................
(8)
(f) _______________________$______________
00
9.
Total (Add lines 7 and 8) ......................................
(9)
(g)_______________________$______________
10.
Net taxable income (or loss) per return (Subtract line
(h)_______________________$______________
00
(10)
9 from line 6) ........................................................
(i) _______________________$______________
(j) _______________________$______________
(k)_______________________$______________
Total ........................................................
00
(5)
Total (Add lines 1 through 5) ......................
6.
00
(6)
Retention Period: Ten (10) years
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