Form Dr-908 - Insurance Premium Taxes And Fees Return - 2014 Page 5
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12DR-908
R. 01/15
Page 5
Name _____________________________________ FEIN _________________________________ Taxable Year _____________
SCHEDULE VI
WORKERS' COMPENSATION ADMINISTRATIVE ASSESSMENT CREDIT LIMITATION
*** Include Your Florida Carrier and Self Insurance Fund Quarterly Premium Reports if Claiming this Credit***
1.
Workers’ Compensation Premiums Written (Annual Statement - Florida Business, Line 16)*
2.
Multiply Line 1 by .0175 (Self Insurers multiply by .016)
Administrative Assessments Paid to Workers’ Compensation Trust Fund (Florida Carrier and Self
3.
Insurance Fund Quarterly Premium Reports must be attached)
First Quarter Assessment ____________________ b. Second Quarter Assessment __________
a.
Third Quarter Assessment ___________________ d. Fourth Quarter Assessment ___________
c.
Total Administrative Assessments Paid*
Workers’ Compensation Administrative Assessment Credit
4.
*
(Enter the lesser of Line 2 or 3 here and on Schedule III, Line 1)
*
If zero or less, enter -0-
SCHEDULE VII
FLORIDA LIFE & HEALTH INSURANCE GUARANTY ASSOCIATION CREDIT (FLAHIGA)
*** Be Sure To Include Your FLAHIGA Certificates of Contribution if Claiming this Credit ***
Total Class B and C
= Total
Year
- Refunds
x Rate
= Credit Amount
Year
Assessments Paid
Assessments Paid
1983
.001
1983
1984
.001
1984
1985
.001
1985
1986
.001
1986
1987
.001
1987
1988
.001
1988
1989
.001
1989
1990
.001
1990
1991
.001
1991
1992
.001
1992
1993
.001
1993
1994
.001
1994
*
1995
.001
1995
1996
.001
1996
1997
.050
1997
*
1998
.050
1998
1999
.050
1999
2000
.050
2000
2001
.050
2001
2002
.050
2002
2003
.050
2003
2004
.050
2004
2005
.050
2005
2006
.050
2006
2007
.050
2007
2008
.050
2008
2009
.050
2009
2010
.050
2010
2011
.050
2011
2012
.050
2012
2013
.050
2013
1. Total FLAHIGA Credit (Enter here and on Schedule III, Line 6)
(1)
*
In 2002, refunds were issued by FLAHIGA from the 1995 and 1998 assessments. These refunds must be subtracted from the original
assessments to properly calculate the amount of FLAHIGA credit.
(1)
If zero or less, enter -0-
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Parent category: Financial