Form T-71 - Insurance Companies Tax Return Of Gross Premiums - 2012
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4State of Rhode Island and Providence Plantations
Form T-71
INSURANCE COMPANIES TAX RETURN OF GROSS PREMIUMS
INSURANCE
for Calendar Year Ending December 31, 2012
2012
Due on or before March 1, 2013
NAME
ADDRESS
CITY
STATE
ZIP CODE
FEDERAL EMPLOYER IDENTIFICATION NUMBER
E-MAIL ADDRESS
STATE OR COUNTRY OF INCORPORATION OR ORGANIZATION
COMPANY TYPE: STOCK, MUTUAL OR PARTICIPATING
ATTACH LEGIBLE COPY OF SCHEDULE T AND SCHEDULE OF DIRECT BUSINESS IN THIS
Schedule A - Computation of Tax
STATE FROM THE ANNUAL STATEMENT SUBMITTED TO THE INSURANCE COMMISSIONER
1.
a. Direct premiums (Gross premiums less return premiums from Schedule T, Part 1 of
1a.
Annual Statement to Insurance Commissioner) ....................................................................
b. Reinsurance assumed from companies not authorized to do business in Rhode Island
1b.
(covering property and risks in RI) .........................................................................................
2.
2.
TOTAL PREMIUMS. Add lines 1a and 1b ......................................................................................................................
Deductions
.
.
3
a. Dividends paid or credited to policyholders - Direct (Mutual & Mutual Plan Companies Only)
3a
b. Direct ocean marine premiums (Gross premiums less return premiums) ..........................
3b.
c. Capital investments deduction ............................................................................................
3c.
d. Tax Incentives for Employers deduction - RIGL §44-55. Attach Form RI-107.................... 3d.
4.
TOTAL DEDUCTIONS. Add lines 3a, 3b, 3c and 3d......................................................................................................
4.
Tax and Fee
5.
Net taxable premium. Subtract line 4 from line 2............................................................................................................
5.
Amount
6.
a. Rhode Island tax. Rate: 2%. Multiply line 5 by the tax rate of 2% (0.02).........................
6a.
b. Retaliatory tax from page 2, Schedule B, line 3 .................................................................
6b.
7.
7.
TOTAL TAX DUE. Add lines 6a and 6b ..........................................................................................................................
8.
RI Credits from page 2, Schedule D, line 14 ...................................................................................................................
8.
.
.
9
TAX AFTER CREDITS. Subtract line 8 from line 7. If zero or less, enter zero.............................................................
9
10.
FEES under Retaliatory Provisions from page 2, Schedule C, line 3 .............................................................................
10.
11.
TOTAL TAX AND FEES DUE. Add lines 9 and 10 .........................................................................................................
11.
Payments
12.
a. Payments made on 2012 Declaration of Estimated Tax ..................................................... 12a.
b. Other payments................................................................................................................... 12b.
13.
TOTAL PAYMENTS. Add lines 12a and 12b ..................................................................................................................
13.
Balance Due
14.
Net tax due. Subtract line 13 from line 11.......................................................................................................................
14.
15.
Interest due (a) Late payment interest _____________ (b) Underestimating interest _____________ Total (a) + (b)
15.
TOTAL DUE WITH RETURN. Add lines 14 and 15 .......................................................................................................
16.
16.
Refund
17.
Overpayment. Subtract lines 11 and 15 from line 13......................................................................................................
17.
18.
Amount of overpayment to be applied to Estimated Tax for 2013 Calendar Year ..........................................................
18.
19.
Amount to be refunded. Subtract line 18 from line 17....................................................................................................
19.
CERTIFICATION: This certification must be executed or the return must be sworn before some person authorized to administer oaths.
Under penalties of perjury, I hereby certify that I have personal knowledge of the statements and other information constituting this return, that the same are true, correct
and complete to the best of my knowledge and belief.
Date
Signature of authorized officer
Title
Date
Signature of preparer
Address of preparer
MAY THE DIVISION CONTACT YOUR PREPARER ABOUT THIS RETURN? YES
NO
Phone number
Key #13
MAILING ADDRESS: RI DIVISION OF TAXATION, ONE CAPITOL HILL, PROVIDENCE, RI 02908-5811
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