California Form 570 - Nonadmitted Insurance Tax Return - 2013 Page 4
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4• Give the FTB any information that is missing
Attach copies of all contracts where there was a
Column e – Enter the total premium amount for
from the return.
reduction of premiums returned or cancellation
each contract.
• Call the FTB for information about the
on which nonadmitted insurance tax was paid.
Total – Enter the total of Form 570, Side 2,
processing of the return or the status of any
column e.
Line 6 – Enter the amount of overpayment you
related refund or payments.
requested to be applied from a prior quarter
• Respond to certain FTB notices about math
Additional Information
that was not applied on a previously filed return.
errors, offsets, and return preparation.
These payments may include amounts from an
• The entity is not authorizing the paid preparer
If you have questions, contact: FTB Nonadmitted
amended Form 570. Enter the calendar quarter
to receive any refund check, bind the entity to
and taxable year as MM-YYYY of the calendar
Insurance Desk at 916.845.7448 or call the
anything (including any additional tax liability),
Withholding Services and Compliance automated
quarter the overpayment occurred. For example,
or otherwise represent the entity before the
number at 888.792.4900.
if the calendar quarter and tax year is September
FTB.
30, 2010, enter 09-2010.
OR write to:
The authorization will automatically end one year
Line 7 – Enter any payments made before filing
WITHHOLDING SERVICES AND
from the date this tax return was filed. If the entity
the return. If the return is being filed after the due
COMPLIANCE MS F182
wants to expand the paid preparer’s authorization,
date, see the instructions for line 10.
FRANCHISE TAX BOARD
get form FTB 3520, Power of Attorney Declaration
PO BOX 942867
Line 9 – If the amount on line 4 is more than the
for the Franchise Tax Board. If the entity wants to
SACRAMENTO CA 94267-0651
amount on line 8, subtract line 8 from line 4 and
revoke the authorization before it ends, notify the
enter the balance on line 9, you have tax due. If
You can download, view, and print California tax
FTB in writing or call 800.852.5711.
the amount on line 8 is more than the amount on
forms and publications at ftb.ca.gov.
line 4, subtract line 4 from line 8 and enter the
Specific Instructions
OR to get forms by mail write to:
result in brackets on line 9, your credits exceed
TAX FORMS REQUEST UNIT MS F284
your tax.
Part I – Policyholder
FRANCHISE TAX BOARD
Line 10 – If you do not pay the tax due by the
PO BOX 307
Enter the business or individual policy holder
due date, a penalty of 10% of the amount of tax
RANCHO CORDOVA CA 95741-0307
name, Doing Business As (DBA), if applicable,
due will be imposed. Enter 10% of the amount of
For all other questions unrelated to withholding
address, and identification number. Print
tax not paid by the due date. (A penalty of 25%
or to access the TTY/TDD numbers, see the
all information using CAPITAL LETTERS. If
of the amount of tax due will be imposed when
information below.
completing Form 570 by hand, enter all the
nonpayment or late payment is due to fraud.)
information requested using black or blue ink.
Internet and Telephone Assistance
Line 11 – Interest will be charged on any late
payment and penalty from the due date to the
Website:
ftb.ca.gov
Part II – Tax Computation
date paid. Interest compounds daily and the
Telephone:
800.852.5711 from within the
Do not show net or negative amounts on line 1
interest rate is adjusted twice a year. If you do not
United States
through line 4 to account for returned premiums.
include interest with your late payment or include
916.845.6500 from outside the
See line 5 for returned premiums. Only use line 1
only a portion of it, the FTB will compute the
United States
through line 4 to report taxable premiums paid or
interest and bill you for it.
TTY/TDD:
800.822.6268 for persons with
to be paid during the calendar quarter.
hearing or speech impairments
Line 12 – Enter the total amount due. Make your
Line 1 – Enter all gross premiums paid or to be
check or money order payable to the “Franchise
Asistencia Por Internet y Teléfono
paid on risks located entirely within California
Tax Board.” Write the calendar quarter (March,
Sitio web:
ftb.ca.gov
for policies entered into or renewed during the
June, September, or December), the applicable
Teléfono:
800.852.5711 dentro de los Estados
calendar quarter.
taxable year, Form 570, and your social security
Unidos
number (SSN), individual taxpayer identification
Line 2 – Enter all gross premiums paid or to
916.845.6500 fuera de los Estados
number (ITIN), California corporation number,
be paid by California home state insured for all
Unidos
federal employer identification number (FEIN), or
policies issued by a nonadmitted insurer for
TTY/TDD:
800.822.6268 personas con
California Secretary of State (SOS) file no. on the
coverage both inside and outside of California
discapacidades auditivas y del habla
check or money order. Check the EFT box if you
which were entered into or renewed during the
made your payment by EFT.
calendar quarter. Note: Enter only premiums for
policies related to risks within the U.S.
Electronic Funds Transfer (EFT) – To submit your
nonadmitted insurance tax payment using EFT,
Line 5 – Enter three percent (.03) of the
use the following tax type code, EFT code 02020.
premiums returned during the calendar quarter
You must use the correct EFT code to ensure
because of cancellation or reduction of premiums
proper credit to your FTB account.
on which nonadmitted insurance tax was paid.
Line 14 – Enter the amount of overpayment to be
Enter the quarter that the returned premiums were
credited to your next quarter’s return.
originally taxed. If the returned premiums are from
more than one quarter or policy, attach a schedule
Part III – Insurance Contracts
showing the amount of returned premiums from
each quarter and/or policy.
Column a – Enter the policy number for each
contract. Enter only policies related to risks within
Returned premiums must be claimed on a return
the U.S.
for the calendar quarter during which the returned
premiums were received. Refunds resulting from
Column b – Enter the name of all the Nonadmitted
returned premiums must be claimed within four
Insurance Companies for each contract.
years from the original due date of the return, four
Column c – Enter the type of insurance coverage
years from the date the return was filed or one
provided by the contract.
year from the date of cancellation or reduction of
Column d – Enter the full name or the two letter
premium, whichever is later.
abbreviation of the state where the risk is located
If you are an agent or broker filing this return on
for each contract. If your policy covers more than
behalf of the insured, the refund will be mailed to
one state, then use additional lines to list the
you in the name of the insured if a signed Power
locations of the risk separately.
of Attorney is on file allowing the FTB to do so.
Page 2 Form 570 Instructions 2012
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