Form Ib-33 - Gross Premium Tax Return Property And Casualty Companies Page 2

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Legal Name
FEIN
Page 2, Form IB-33, Web, 12-12
Schedule B. Calculation of Gross Premium Tax
Part 1. North Carolina Basis Gross Premium Tax
(Multiply NC Taxable Premiums by Applicable Tax Rate)
NC Taxable Premiums
Tax Computed on NC Basis
Tax Rate
,
,
,
.
,
,
,
.
00
00
1.
Life Insurance
1.9%
,
,
,
.
,
,
,
.
Annuities
00
00
2.
0%
,
,
,
,
,
,
.
.
Accident and Health
00
00
3.
1.9%
,
,
,
.
,
,
,
.
00
00
4.
Workers’ Comp
2.5%
,
,
,
.
,
,
,
.
All Other Lines (attach schedule)
00
00
5.
1.9%
,
,
,
.
,
,
,
.
00
00
6.
Finance Charges
1.9%
,
,
,
,
,
,
.
.
7.
Total
00
00
Add Lines 1 through 6
Part 2. State of Domicile Basis Gross Premium Tax
(Enter state of domicile tax rate in the Tax Rate column. Multiply NC Taxable Premiums
by the Tax Rate. Attach supplemental schedule showing detail of taxable premiums and tax computation if space provided is inadequate.)
NC Taxable Premiums
Tax Rate
Tax Computed on State of Domicile Basis
,
,
,
.
,
,
,
.
00
00
1.
Life Insurance
%
,
,
,
.
,
,
,
.
Annuities
00
00
2.
%
,
,
,
,
,
,
.
.
Accident and Health
00
00
3.
%
,
,
,
,
,
,
.
.
00
00
Workers’ Comp
4.
%
,
,
,
.
,
,
,
.
All Other Lines (attach schedule)
00
00
5.
%
,
,
,
.
,
,
,
.
00
00
6.
Finance Charges
%
,
,
,
.
,
,
,
.
7.
Total
00
00
Add Lines 1 through 6
Part 3.
Computation of Gross Premium Tax
,
,
,
.
1. Gross Premium Tax Computed on NC Basis
00
1.
(From Part 1,Total Tax Computed)
,
,
,
.
2. Retaliatory Tax
00
2.
Part 2, Total Tax Computed minus Part 1, Total Tax Computed, but not less than zero.
,
,
,
.
3. Gross Premium Tax
00
3.
Line 1 plus Line 2
,
,
,
.
4. Tax Credits
00
4a.
a. NC Guaranty Fund Assessment Credit (From Schedule E, total; not to exceed Line 3)
,
,
,
.
00
b. CD-425 and NC-478 Tax Credits (Attach applicable forms)
4b.
,
,
,
.
5. Gross Premium Tax Liability
00
5.
Line 3 minus Lines 4a and 4b, but not less than zero
,
,
,
.
6. Prior Year Credit Applied to 2012
00
6.
(From Schedule D, Line 1, Column 1)
,
,
,
.
7. Gross Premium Tax Installment Payments
00
7.
(From Schedule D, Line 5, Column 1)
,
,
,
.
8. Balance of Gross Premium Tax Due
00
8.
Line 5 minus Lines 6 and 7, but not less than zero. If less than zero, enter amount on Line 11.
(See for current
,
.
,
.
9. a. Penalties
b. Interest
interest rate and penalty information)
00
00
,
,
,
.
$
00
10. Total Gross Premium Tax Due
10.
(Add Lines 8, 9a and 9b)
,
,
,
.
11. Overpayment
00
11.

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