Fillable Form 570 - Nonadmitted Insurance Tax Return

Line 2a – Enter the total premiums paid or to

Line 0 – If you do not pay the tax due by

For all other questions unrelated to withholding

be paid on contracts covering risks located

the due date, a penalty of 10% of the amount

or to access the TTY/TDD numbers, see the

within and outside of California for contracts

of tax due will be imposed. Enter 10% of the

information below.

entered into or renewed during the calendar

amount of tax not paid by the due date. (A

Internet and Telephone Assistance

quarter.

penalty of 25% of the amount of tax due will be

Website:

ftb.ca.gov

imposed when nonpayment or late payment is

Line 2b – Enter the amount of premiums on

Telephone: 800.852.5711 from within the

due to fraud.)

line 2a allocated to California. You must attach

United States

a schedule showing how you determined the

Line – Interest will be charged on any late

916.845.6500 from outside the

allocation.

payment and penalty from the due date to the

United States

date paid. Interest compounds daily and the

The amount of premiums allocated to California

TTY/TDD:

800.822.6268 for persons with

interest rate is adjusted twice a year. If you

is determined by allocating to this state that

hearing or speech impairments

do not include interest with your late payment

proportion that the total premium on the

Asistencia Por Internet y Teléfono

or include only a portion of it, the FTB will

insured properties or operations in this state,

Sitio web:

ftb.ca.gov

compute the interest and bill you for it.

as computed on the exposure in this state on

Teléfono:

800.852.5711 dentro de los

the basis of any single standard rating method

Line 2 – Enter the total amount due. Make

Estados Unidos

in use in all states or countries where the

your check or money order payable to the

916.845.6500 fuera de los

insurance applies, bears to the total premium so

“Franchise Tax Board.” Be sure to write the

Estados Unidos

computed in all states or countries in which that

calendar quarter (March, June, September,

TTY/TDD:

800.822.6268 personas con

nonadmitted insurance may apply or, with prior

or December), the applicable taxable year,

discapacidades auditivas y del

approval of the FTB, any other reasonable basis.

Form 570, and your social security number,

habla

individual taxpayer identification number,

Allocate each contract individually if more than

California corporation number, FEIN, or SOS

one contract were entered into or renewed

file no. on the check or money order. Check the

during the calendar quarter.

EFT box if you made your payment by EFT.

Line 5 – Enter three percent (.03) of the

Line 4 – Enter the amount of overpayment to

premiums returned during the calendar

be credited to your next return.

quarter because of cancellation or reduction of

premiums on which nonadmitted insurance tax

Additional Information

was paid.

Enter the quarter that the returned premiums

You can download, view, and print California

were originally taxed. If the returned premiums

tax forms and publications at ftb.ca.gov.

are from more than one quarter or policy, attach

If you have questions, contact:

a schedule showing the amount of returned

FTB Nonadmitted Insurance Desk at

premiums from each quarter and/or policy.

916.845.4098 or call the Withholding Services

Returned premiums must be claimed on a

and Compliance automated number at

return for the calendar quarter during which

888.792.4900.

the returned premiums were received. Refunds

OR write to:

resulting from returned premiums must be

WITHHOLDING SERVICES AND

claimed within four years from the date of

COMPLIANCE MS F182

cancellation or reduction of premium.

FRANCHISE TAX BOARD

If you are an agent or broker filing this return

PO BOX 942867

on behalf of the insured, the refund will be

SACRAMENTO CA 94267-0651

mailed to you in the name of the insured if a

signed Power of Attorney is on file allowing the

FTB to do so.

TAX FORMS REQUEST UNIT MS F284

FRANCHISE TAX BOARD

Line 7 – Enter any payments made before filing

PO BOX 307

the return. If the return is being filed after the

RANCHO CORDOVA CA 95741-0307

due date, see the instructions for line 10.

Line 9 – If the amount on line 4 is more than

the amount on line 8, subtract line 8 from line

4 and enter the balance on line 9, you have tax

due. If the amount on line 8 is more than the

amount on line 4, subtract line 4 from line 8

and enter the result in brackets on line 9, your

credits exceed your tax.

Page 2 Form 570 Instructions 2010 (REV 08-11)

Form 570 - Nonadmitted Insurance Tax Return - 2011 Page 4

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