Form T-69es-Ins - Declaration Of Gross Premium Insurance Estimated Tax - 2013
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1DECLARATION OF GROSS PREMIUM INSURANCE
ESTIMATED TAX VOUCHER INSTRUCTIONS
1. Every insurance company liable for the gross premium tax shall file a declaration of its estimated tax for the calendar year
if its estimated tax for such taxable year can reasonably be expected to exceed $500.00. The entire amount of such
estimated tax shall constitute the amount of advance required to be paid.
2. The amounts and due dates of the installments are as follows:
--> 40% by March 15th of the calendar year
--> 60% by June 15th of the calendar year.
3. Every insurance company is subject to an assessment of 18% per annum for underpayments and penalties for the willful
neglect or failure to file a declaration or pay any installment due thereunder.
4. When there is not an increase in the tax rate from one year to the next, no interest or penalty will occur for underestimated
tax payment, if prepayments are made equal to the prior year’s tax.
5. Mail voucher and payment to:
RI Division of Taxation
One Capitol Hill - Suite 9
Providence, RI 02908-5811
Payments can be made online. For more information, visit: https://
If your estimate is zero or you make your payment online, you do not need to send in this estimated tax form.
2013
T-69ES-INS
STATE OF RHODE ISLAND
DIVISION OF TAXATION * ONE CAPITOL HILL SUITE 9, PROVIDENCE, RI 02908-5811
Calendar Year
DECLARATION OF GROSS PREMIUM INSURANCE ESTIMATED TAX
SECOND ESTIMATE
NAME
1. TOTAL TAX FOR PRIOR
$
0 0
YEAR
ADDRESS
$
0 0
2. ESTIMATED TAX FOR
CURRENT YEAR
T-69ES-INS
CITY, STATE, ZIP CODE
0 0
$
3. 60% OF LINE 2
FEDERAL EMPLOYER IDENTIFICATION NUMBER
4. LESS AMOUNT FROM
0 0
$
PRIOR YEAR CREDITED
TO THIS PAYMENT
I declare, under the penalties of perjury, that this document has been examined by me and,
to the best of my knowledge and belief, is true, and complete.
5. PAYMENT DUE WITH THIS
$
0 0
VOUCHER
Signature of officer or agent
AMOUNT ON LINE 5 IS DUE AND PAYABLE ON OR BEFORE JUNE 15TH
Key #13
Title
Date
2013
T-69ES-INS
STATE OF RHODE ISLAND
DIVISION OF TAXATION * ONE CAPITOL HILL SUITE 9, PROVIDENCE, RI 02908-5811
Calendar Year
DECLARATION OF GROSS PREMIUM INSURANCE ESTIMATED TAX
FIRST ESTIMATE
NAME
1. TOTAL TAX FOR PRIOR
$
0 0
YEAR
ADDRESS
$
2. ESTIMATED TAX FOR
0 0
CURRENT YEAR
T-69ES-INS
CITY, STATE, ZIP CODE
0 0
$
3. 40% OF LINE 2
FEDERAL EMPLOYER IDENTIFICATION NUMBER
4. LESS AMOUNT FROM
0 0
$
PRIOR YEAR CREDITED
TO THIS PAYMENT
I declare, under the penalties of perjury, that this document has been examined by me and,
to the best of my knowledge and belief, is true, and complete.
5. PAYMENT DUE WITH THIS
$
0 0
VOUCHER
Signature of officer or agent
AMOUNT ON LINE 5 IS DUE AND PAYABLE ON OR BEFORE MARCH 15TH
Key #13
Title
Date
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