Form 802 - Virginia Insurance Premiums License Tax Surplus Lines Broker'S Annual Reconciliation Tax Report - 2014 Page 2
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1
2
3Return” box at the top of Form 802. File the amended
Line 3
Add Line 1 and Line 2.
report within three years from the due date of the
Line 4
Enter the portion of premiums returned to an
original report. See Va. Code § 58.1-1823.
insured whose home state is Virginia as a result of an
Quarterly Tax Reports: A surplus lines broker
insurance rider, policy cancellation, rate adjustment,
must file quarterly tax reports using Form 801 if its
or an excess of advance premium over the actual
annual Insurance Premiums License Tax liability can
premium.
reasonably be expected to exceed $1,500 and, during
Line 5
Subtract Line 4 from Line 3.
the quarter, it derived direct gross premium income
Line 6
Enter the Insurance Premiums License Tax
from policies for insureds whose home state is the
liability amount by multiplying the amount on Line 5 by
Commonwealth of Virginia. Refer to the Form 801
2.25 percent.
instructions for more information.
Line 7
Enter the total quarterly Insurance Premiums
Penalties and Interest: The Virginia Surplus Lines
License Tax amount paid during the year.
Broker’s Annual Reconciliation Tax Report is subject
to a late filing fine of $50 per day for each day’s failure
Line 8
If Line 6 is greater than Line 7, subtract Line
to submit the report. All payments made after the due
7 from Line 6 and enter that amount on Line 8.
date are also subject to a 10 percent late payment
Line 9
If Line 7 is greater than Line 6, subtract Line
penalty that shall be added to the amount of the unpaid
6 from Line 7 and enter that amount on Line 9.
tax liability. Virginia law requires the Department to
Line 10 Enter the Fee for Late Filing. Surplus Lines
assess interest on any unpaid balance of unpaid tax,
Brokers are subject to a $50 late filing fine for each
from the payment due date through the date the tax is
day that the report is late.
paid. Interest charges apply to late payments as well
as additional balances due or assessed as the result
Line 11 Enter the amount of the Penalty for Late
of audit adjustments. Va. Code § 58.1-15 sets the
Payment. If you pay the tax owed after the due date,
interest for late payments at the federal underpayment
you will be subject to a penalty of 10 percent of the tax
rate established under Internal Revenue Code §
due amount on Line 8.
6621, plus 2 percent. For the current daily interest
Line 12 Upon failure to pay the annual Insurance
rate, contact the Department at (804) 367-8037, or at
Premiums
License
Tax
due
with
the
annual
tax-geninfo@tax.virginia.gov.
reconciliation tax report, interest is assessed at the
LINE INSTRUCTIONS
rate of interest established pursuant to Va. Code §
58.1-15 for the period between the due date of the
Taxpayer Information: Enter your name, mailing
annual report and the date of full payment.
address, Virginia Insurance Premiums License Tax
account number, and Virginia broker’s license number
Line 13 Add Lines 10, 11 and 12.
in the spaces provided.
Line 14 If you owe tax on Line 8, add Line 8 and Line
Check the box for all that apply: Check the
13. If you have an overpayment on Line 9 but Line 13
appropriate box if you have an address change or are
is greater than Line 9, subtract Line 9 from Line 13.
filing an amended report.
This is the total payment due. Enter the sum on Line
14 and on the Virginia Insurance Premiums License
Line 1
Enter the gross amount of all premiums,
Tax Surplus Lines Broker’s Annual Reconciliation Tax
assessments, dues, and fees collected, received, or
Report Voucher, Form 802V.
derived, or obligations taken from policies for insureds
whose home state is Virginia.
Line 15 If you have an overpayment on Line 9 and
Line 9 is greater than Line 13, subtract Line 13 from
Line 2
Enter the amount of premiums written for
Line 9. This is your refund. Enter the sum on Line 15.
additional insurance coverage for insureds whose
Sign and date your report.
home state is Virginia as a result of an insurance rider
or rate adjustment, or an advance premium that is less
than the actual premium.
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