Form 207f Esa - Estimates, Estimated Insurance Premiums Tax Payment Coupon Foreign And Nonresident Insurance Companies Page 2

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Who Must File This Coupon
Required Annual Payment
Each foreign or nonresident insurance company carrying on an insurance
For estimated insurance premiums tax purposes, a foreign or nonresident
business in Connecticut whose insurance premiums tax, after the application
insurance company’s required annual payment is the lesser of:
of guaranty association assessment credits, Insurance Department
•
90% (.90) of the tax that will be shown on its 2005 Form 207F (after the
assessment credit (if applicable), and general business tax credits (as defined
application of guaranty association assessment credits, the Insurance
in Special Notice 2003(17), 2003 Legislation Affecting the Insurance
Department assessment credit (if applicable), and general business tax
Premiums Tax), for calendar year 2005 will be $1,000 or more must file this
credits); or
coupon.
•
100% of the tax shown on your 2004 Form 207F, Line 15.
Interest
If the payment due with this coupon is not made on or before the due date of
this coupon, interest will accrue at the rate of 1% (.01) per month, or fraction
of a month, on the amount not paid from the due date of this coupon until the
date of payment.
Schedule 1
1 Enter estimated insurance premiums tax due for calendar year 2005 prior to the application of guaranty association
assessment credits, Insurance Department assessment credit (if applicable), and general business tax credits.
00
2 Multiply Line 1 by 70% (.70)
00
3 Enter estimated Insurance Department assessment credit (if applicable), and general business tax credits against
insurance premiums tax due for calendar year 2005. (May not exceed amount entered on Line 2)
00
4 Subtract Line 3 from Line 1
00
5 Multiply Line 4 by 27% (.27)
00
207F ESA Back (Rev. 5/05)
Who Must File This Coupon
Required Annual Payment
Each foreign or nonresident insurance company carrying on an insurance
For estimated insurance premiums tax purposes, a foreign or nonresident
business in Connecticut whose insurance premiums tax, after the application
insurance company’s required annual payment is the lesser of:
of guaranty association assessment credits, Insurance Department
•
90% (.90) of the tax that will be shown on its 2005 Form 207F (after the
assessment credit (if applicable), and general business tax credits (as defined
application of guaranty association assessment credits, the Insurance
in Special Notice 2003(17), 2003 Legislation Affecting the Insurance
Department assessment credit (if applicable), and general business tax
Premiums Tax), for calendar year 2005 will be $1,000 or more must file this
credits); or
coupon.
•
100% of the tax shown on your 2004 Form 207F, Line 15.
Interest
If the payment due with this coupon is not made on or before the due date of
this coupon, interest will accrue at the rate of 1% (.01) per month, or fraction
of a month, on the amount not paid from the due date of this coupon until the
date of payment.
Schedule 1
1 Enter estimated insurance premiums tax due for calendar year 2005 prior to the application of guaranty association
assessment credits, Insurance Department assessment credit (if applicable), and general business tax credits.
00
2 Multiply Line 1 by 70% (.70)
00
3 Enter estimated Insurance Department assessment credit (if applicable), and general business tax credits against
insurance premiums tax due for calendar year 2005. (May not exceed amount entered on Line 2)
00
4 Subtract Line 3 from Line 1
00
5 Multiply Line 4 by 54% (.54)
00
207F ESB Back (Rev. 5/05)
Who Must File This Coupon
Required Annual Payment
For estimated insurance premiums tax purposes, a foreign or nonresident
Each foreign or nonresident insurance company carrying on an insurance
business in Connecticut whose insurance premiums tax, after the application
insurance company’s required annual payment is the lesser of:
of guaranty association assessment credits, Insurance Department
•
90% (.90) of the tax that will be shown on its 2005 Form 207F (after the
assessment credit (if applicable), and general business tax credits (as defined
application of guaranty association assessment credits, the Insurance
in Special Notice 2003(17), 2003 Legislation Affecting the Insurance
Department assessment credit (if applicable), and general business tax
Premiums Tax), for calendar year 2005 will be $1,000 or more must file this
credits); or
coupon.
•
100% of the tax shown on your 2004 Form 207F, Line 15.
Interest
If the payment due with this coupon is not made on or before the due date of
this coupon, interest will accrue at the rate of 1% (.01) per month, or fraction
of a month, on the amount not paid from the due date of this coupon until the
date of payment.
Schedule 1
1 Enter estimated insurance premiums tax due for calendar year 2005 prior to the application of guaranty association
assessment credits, Insurance Department assessment credit (if applicable), and general business tax credits.
00
2 Multiply Line 1 by 70% (.70)
00
3 Enter estimated Insurance Department assessment credit (if applicable), and general business tax credits against
insurance premiums tax due for calendar year 2005. (May not exceed amount entered on Line 2)
00
4 Subtract Line 3 from Line 1
00
5 Multiply Line 4 by 72% (.72)
00
207F ESC Back (Rev. 5/05)
Who Must File This Coupon
Required Annual Payment
Each foreign or nonresident insurance company carrying on an insurance
For estimated insurance premiums tax purposes, a foreign or nonresident
business in Connecticut whose insurance premiums tax, after the application
insurance company’s required annual payment is the lesser of:
of guaranty association assessment credits, Insurance Department
•
90% (.90) of the tax that will be shown on its 2005 Form 207F (after the
assessment credit (if applicable), and general business tax credits (as defined
application of guaranty association assessment credits, the Insurance
in Special Notice 2003(17), 2003 Legislation Affecting the Insurance
Department assessment credit (if applicable), and general business tax
Premiums Tax), for calendar year 2005 will be $1,000 or more must file this
credits); or
coupon.
•
100% of the tax shown on your 2004 Form 207F, Line 15.
Interest
If the payment due with this coupon is not made on or before the due date of
this coupon, interest will accrue at the rate of 1% (.01) per month, or fraction
of a month, on the amount not paid from the due date of this coupon until the
date of payment.
Schedule 1
1 Enter estimated insurance premiums tax due for calendar year 2005 prior to the application of guaranty association
assessment credits, Insurance Department assessment credit (if applicable), and general business tax credits.
00
2 Multiply Line 1 by 70% (.70)
00
3 Enter estimated Insurance Department assessment credit (if applicable), and general business tax credits against
insurance premiums tax due for calendar year 2005. (May not exceed amount entered on Line 2)
00
4 Subtract Line 3 from Line 1
00
5 Multiply Line 4 by 90% (.90)
00
207F ESD Back (Rev. 5/05)

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