Form Dexm - Domestic Companies Annual Report

Form Dexm - Domestic Companies Annual Report - 2012 Page 5

DEXM (12-12)

Page 5

If remitting payment by EFT, the Total Amount Due indicated at Schedule A line 27 must be transmitted in one transaction

with an applicable year of 2012. The Prepayment of Tax liability included in this amount, along with the Prepayment of Tax liability

due June 1

, will be credited automatically against the succeeding years’ tax liability, when that years’ Insurance Premium Tax Return

is filed. A separate transaction for the amount of the Prepayment of Tax at line 26 is not required.

HELPFUL HINT FOR EFT REMITTANCE: Return Period Ending MUST read 121231 ((YY) Year, (MM) Month, (DD)

Day) for ALL payments associated with the 2012 tax return. This includes any PREPAYMENT of tax liabilities due with the return

on March 1

and on June 1

. The same procedure should be followed for subsequent tax years, after adjusting the return period

ending accordingly.

IMPORTANT NOTE

PAYMENT for the amount indicated at Schedule A Line 27 of the Insurance Premium Tax Return MUST BE

SUBMITTED TO THE DIVISION OF TAXATION at the address indicated on the first page of this return. DO NOT send the

payment of this amount to the Department of Banking and Insurance.

In addition, if the taxpayer is simultaneously paying an Annual Statement Filing Fee, Renewal of Certificate of Authority

Fee, Maintenance Fee, Insurance Development Fund Surcharge etc., these amounts must be submitted under separate cover to the

address indicated on the notice received for the particular fee, surcharge etc. and MUST NOT be included with the Insurance

Premium Tax Return.

**ALL ATTACHMENTS MUST BE INCLUDED WITH BOTH THE ORIGINAL RETURN FILED WITH THE DIVISION OF

TAXATION AND THE DUPLICATE RETURN FILED SIMULTANEOUSLY WITH THE DEPARTMENT OF BANKING AND

INSURANCE.

Form Dexm - Domestic Companies Annual Report - 2012 Page 5