California Form 570 Draft - Nonadmitted Insurance Tax Return

individual whose signature appears in the “Paid

years from the original due date of the return, four

Column e – Enter the total premium amount for

Preparer’s Use Only” section of the return. It does

years from the date the return was filed or one

each contract.

not apply to the business, if any, shown in that

year from the date of cancellation or reduction of

Total – Enter the total of Form 570, Side 2,

section.

premium, whichever is later.

column e.

If the “Yes” box is checked, the entity is

If you are an agent or broker filing this return on

Additional Information

authorizing the FTB to call the paid preparer

behalf of the insured, the refund will be mailed to

to answer any questions that may arise during

you in the name of the insured if a signed Power

You can download, view, and print California tax

the processing of its return. The entity is also

of Attorney is on file allowing the FTB to do so.

forms and publications at ftb.ca.gov.

authorizing the paid preparer to:

Attach copies of all contracts where there was a

If you have questions, contact: FTB Nonadmitted

• Give the FTB any information that is missing

reduction of premiums returned or cancellation

Insurance Desk at 916.845.4098 or call the

from the return.

on which nonadmitted insurance tax was paid.

• Call the FTB for information about the

Withholding Services and Compliance automated

Line 6 – Enter the amount of overpayment you

number at 888.792.4900.

processing of the return or the status of any

requested to be applied from a prior quarter

related refund or payments.

OR write to:

that was not applied on a previously filed return.

• Respond to certain FTB notices about math

These payments may include amounts from an

WITHHOLDING SERVICES AND

errors, offsets, and return preparation.

amended Form 570. Enter the calendar quarter

COMPLIANCE MS F182

• The entity is not authorizing the paid preparer

and taxable year as MM-YYYY of the calendar

FRANCHISE TAX BOARD

to receive any refund check, bind the entity to

quarter the overpayment occurred. For example,

PO BOX 942867

anything (including any additional tax liability),

if the calendar quarter and tax year is September

SACRAMENTO CA 94267-0651

or otherwise represent the entity before the

30, 2010, enter 09-2010.

FTB.

Line 7 – Enter any payments made before filing

TAX FORMS REQUEST UNIT MS F284

The authorization will automatically end one year

the return. If the return is being filed after the due

FRANCHISE TAX BOARD

from the date this tax return was filed. If the entity

date, see the instructions for line 10.

PO BOX 307

wants to expand the paid preparer’s authorization,

Line 9 – If the amount on line 4 is more than the

RANCHO CORDOVA CA 95741-0307

get form FTB 3520, Power of Attorney Declaration

amount on line 8, subtract line 8 from line 4 and

for the Franchise Tax Board. If the entity wants to

For all other questions unrelated to withholding

enter the balance on line 9, you have tax due. If

revoke the authorization before it ends, notify the

or to access the TTY/TDD numbers, see the

the amount on line 8 is more than the amount on

FTB in writing or call 800.852.5711.

information below.

line 4, subtract line 4 from line 8 and enter the

Internet and Telephone Assistance

result in brackets on line 9, your credits exceed

Specific Instructions

your tax.

Website:

ftb.ca.gov

Telephone:

800.852.5711 from within the

Line 0 – If you do not pay the tax due by the

Part I – Policyholder

United States

due date, a penalty of 10% of the amount of tax

916.845.6500 from outside the

Enter the business or individual policy holder

due will be imposed. Enter 10% of the amount of

United States

name, Doing Business As (DBA), if applicable,

tax not paid by the due date. (A penalty of 25%

TTY/TDD:

800.822.6268 for persons with

address, and identification number. Print

of the amount of tax due will be imposed when

hearing or speech impairments

all information using CAPITAL LETTERS. If

nonpayment or late payment is due to fraud.)

completing Form 570 by hand, enter all the

Asistencia Por Internet y Teléfono

Line – Interest will be charged on any late

information requested using black or blue ink.

payment and penalty from the due date to the

Sitio web:

ftb.ca.gov

date paid. Interest compounds daily and the

Teléfono:

800.852.5711 dentro de los Estados

Part II – Tax Computation

interest rate is adjusted twice a year. If you do not

Unidos

Do not show net or negative amounts on line 1

include interest with your late payment or include

916.845.6500 fuera de los Estados

through line 4 to account for returned premiums.

only a portion of it, the FTB will compute the

Unidos

See line 5 for returned premiums. Only use line 1

interest and bill you for it.

TTY/TDD:

800.822.6268 personas con

through line 4 to report taxable premiums paid or

Line 2 – Enter the total amount due. Make your

discapacidades auditivas y del habla

to be paid during the calendar quarter.

check or money order payable to the “Franchise

Line – Enter all gross premiums paid or to be

Tax Board.” Be sure to write the calendar quarter

paid on risks located entirely within California

(March, June, September, or December), the

for policies entered into or renewed during the

applicable taxable year, Form 570, and your social

calendar quarter.

security number, individual taxpayer identification

number, California corporation number, FEIN, or

Line 2 – Enter all gross premiums paid or to

SOS file no. on the check or money order. Check

be paid by California home state insured for all

the EFT box if you made your payment by EFT.

policies issued by a nonadmitted insurer for

coverage both inside and outside of California

Line 4 – Enter the amount of overpayment to be

which were entered into or renewed during the

credited to your next quarter’s return.

calendar quarter.

Part III – Insurance Contracts

Line 5 – Enter three percent (.03) of the

premiums returned during the calendar quarter

Column a – Enter the policy number for each

because of cancellation or reduction of premiums

contract.

on which nonadmitted insurance tax was paid.

Column b – Enter the name of all the Nonadmitted

Enter the quarter that the returned premiums were

Insurance Companies for each contract.

originally taxed. If the returned premiums are from

Column c – Enter the type of insurance coverage

more than one quarter or policy, attach a schedule

provided by the contract.

showing the amount of returned premiums from

Column d – Location of Risk. Enter the full name

each quarter and/or policy.

of the country or the two letter abbreviation of the

Returned premiums must be claimed on a return

state where the risk is located for each contract.

for the calendar quarter during which the returned

If your policy covers more than one state or

premiums were received. Refunds resulting from

country, then use additional lines to list the

returned premiums must be claimed within four

locations of the risk separately.

Page 2 Form 570 Instructions 2011

California Form 570 Draft - Nonadmitted Insurance Tax Return - 2012 Page 5

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