Form Rct-124 - Underwriting Profits Tax - Domestic And Foreign Marine Insurance Page 4
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4RCT-124
Revenue ID
PAGE 4 OF 4
(09-14)
SCHEDULE E
MARINE LOSSES INCURRED ON BUSINESS WRITTEN WITHIN THE U.S.
FOR LAST THREE CALENDAR YEARS
1
2
3
4
5
6
NET
LAST THREE
GROSS
TOTAL
REINSURANCE
SALVAGE
(Column 2 minus
CALENDAR YEARS
LOSSES
(Columns 3 and 4)
Column 5)
a
Year
b
Year
c
Year
d
Totals
SCHEDULE F
SPECIFIC MARINE EXPENSES INCURRED ON BUSINESS TRANSACTED WITHIN THE U.S.
1
2
3
4
5
6
7
8
AGENCY
TOTAL
LAST THREE
AGENCY
FEDERAL
STATE & CITY
LOSS
ALL OTHER
COMMISSIONS
COLUMNS 2
CALENDAR
EXPENSES
TAXES
TAXES & FEES
ADJUSTMENT
EXPENSES
INCLUDING
THROUGH 7
EXPENSE
YEARS
BROKERAGE
a
Year
b
Year
c
Year
d
Totals
SCHEDULE G
GENERAL EXPENSES NOT CHARGEABLE SPECIFICALLY TO ANY PARTICULAR CLASS OF BUSINESS
1
2
3
4
5
6
7
8
ADVERTISING
LAST THREE
SALARIES OF
FEDERAL
RENTS
PRINTING &
ALL OTHER
TOTAL
&
OFFICERS &
CALENDAR
TAXES
STATIONERY
EXPENSES
COLUMNS 2
SUBSCRIP-
EMPLOYEES
YEARS
THROUGH 7
TIONS
a
Year
b
Year
c
Year
d
Totals
Three-year ratio of U.S. marine premiums (Schedule A, Column 4, Item d) to total net premiums for all classes
e.
of business within the U.S. (Schedule C, Column 4, Item d). Calculate to six decimal places . . . . . . . . . . . . . . .
Three-year ratio of net marine premiums written within Pennsylvania (Schedule B, Column 4, Item d) to total
f.
net marine premiums written within the U.S. (Schedule A, Column 4, Item d). Calculate to six decimal places . .
Attach Copy of Pennsylvania Business Page of the Annual Report filed with the Pennsylvania Insurance Department.
NOTE: If the company is licensed to write ocean marine premiums in Pennsylvania, this report must be filed whether or not
ocean marine premiums were written.
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