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Form 207F-5

Instructions

General Instructions

Line 12a: Late Payment Penalty: Multiply Line 11 by 10%. Enter

the result or $50, whichever is greater.

Complete this return in blue or black ink only.

Line 12b: Multiply Line 11 by 1% per month or fraction of a month

Use Form 207F-5, Insurance Premiums Tax Return Nonresident

from the original due date of the return to the date of payment.

and Foreign Companies Initial Five-Year Return, to report net direct

premiums received during the ﬁ ve preceding calendar years from

Line 13: Add Line 11 and Line 12.

policies written on property or risks located or resident in Connecticut

Make check payable to Commissioner of Revenue Services. To

except ocean marine insurance.

ensure payment is applied to your account, write “Form 207F-5”

Due Date: Each newly licensed nonresident or foreign insurance

and your Connecticut Tax Registration Number on the front of your

company must ﬁ le this return within 45 days of the company’s initial

check. Be sure to sign your check and paper clip it to the front of

license to transact business in Connecticut.

your return. Do not send cash. DRS may submit your check to

your bank electronically.

Attachments: Attach the following to this return:

•

Mail to: Department of Revenue Services

A copy of Schedule T for the ﬁ ve preceding calendar years;

State of Connecticut

and

PO Box 2990

•

A copy of the Connecticut business page from the Annual

Hartford CT 06104-2990

Statement ﬁ led with the Insurance Department for the ﬁ ve

preceding calendar years.

Failure to ﬁ le or failure to pay the proper amount of tax due will

result in penalty and interest charges. It is to your advantage to

Rounding Off to Whole Dollars: You must round off cents to the

ﬁ le when your return is due whether or not you are able to make

nearest whole dollar on your return and schedules. If you do not

full payment.

round the Department of Revenue Services (DRS) will disregard

the cents.

Signature: The treasurer of the company, or a principal ofﬁ cer of

the company, must sign Form 207F-5.

Round down to the next lowest dollar all amounts that include 1

through 49 cents. Round up to the next highest dollar all amounts

Paid Preparer Signature: A paid preparer must sign and date

that include 50 through 99 cents. However, if you need to add two

Form 207F-5. Paid preparers must also enter their Social Security

or more amounts to compute the amount to enter on a line, include

Number (SSN) or Preparer Tax Identiﬁ cation Number (PTIN), and

cents and round off only the total.

their ﬁ rm’s FEIN in the spaces provided.

Example: Add two amounts ($1.29 + $3.21) to compute the total

Pay Electronically

($4.50) to enter on a line. $4.50 is rounded to $5.00 and entered

Visit to make a direct tax

on the line.

payment electronically. Using this option

authorizes DRS to electronically withdraw a

Line Instructions

payment from your bank account (checking or savings) on a date

Line 1: Enter gross direct premiums (less return premiums, including

you select up to the due date. If you pay electronically you must still

cancellations) received during the ﬁ ve preceding calendar years

ﬁ le your return on or before the due date.

from policies written on property or risks located or resident in this

state, but excluding annuity considerations and premiums received

For More Information

for reinsurance assumed from other companies.

Call DRS during business hours, Monday through Friday:

Line 2: Enter dividends paid to policyholders on direct business for

1-800-382-9463 (Connecticut calls outside the Greater Hartford

•

the ﬁ ve preceding calendar years. Do not include any dividends paid

calling area only), or

on account of the ownership of stock.

860-297-5962 (from anywhere).

•

Line 3: Enter net direct premiums received during the ﬁ ve preceding

TTY, TDD, and Text Telephone users only may transmit inquiries

calendar years from ocean marine insurance policies written on

anytime by calling 860-297-4911.

property located in this state.

Line 4: Enter benefit payments from group health insurance

Forms and Publications

premiums to the extent allowed by Conn. Gen. Stat. §12-210a for

Visit the DRS website at to download and print

the ﬁ ve preceding calendar years.

Connecticut tax forms and publications.

Line 8 and Line 9: Summarize and attach schedules to support

taxes and other obligations claimed on Line 8 during the ﬁ ve

preceding calendar years. Apply Connecticut data to your state’s

forms for ﬁ re marshal, franchise, ocean marine, premium, and other

taxes to determine the amounts a Connecticut insurance company

would be required to pay in your state.

Line 8 and Line 9 include other taxes and assessments net of tax

offsets allowed. Do not include ad valorem taxes on real or personal

property; personal income taxes; fees for agents’ licenses; or

special purpose assessments, including but not limited to, workers

compensation assessments and insurance guaranty fund assessments.

Form 207F-5 Back (Rev. 12/14)

Form 207f-5 - Insurance Premiums Tax Return Nonresident And Foreign Companies Initial Five-Year Return Page 2

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