Form 63-29a - Ocean Marine Profits Tax Return - 2011 Page 2

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Dividend Deduction Schedule
Enter dividends paid or credited to policyholders during the taxable year 2011 for United States marine business subject to Section 29A of MGL, Chapter 63.
11 On direct business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
12 On reinsurance assumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
13 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Less dividends received on reinsurance paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
15 Net dividends paid or credited during 2011 on U.S. 29A Marine (from Profit Schedule, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Federal Income Tax Deduction Schedule
Lines 6 through 12 refer to Profit Schedule, line 10.
16 Total amount of federal income tax (actual) on business year 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Give date for filing federal return __________________________.
In support of line 6, furnish a copy of your U.S. Corporation Income Tax Return, Form 1120. State the amount of underwriting gain and of investment income
that comprise “Taxable Income” in line 30 of said return. If above date indicates federal return is not yet filed, state that line 6 is estimated. Submit afore-
mentioned copy when available and the recomputation of lines 6 to 12 if necessary.
Total tax on
Part of 6 covering
17 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Normal tax
or Normal and surtax
Excess profits tax
18 Underwriting gain . . . . . . . . . . . . . . . . . . . . . . . . 8
19 Underwriting profit — all classes (Insurance Expense Exhibit, Part II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Underwriting profit (United States 29A Marine from page 3, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Underwriting profit — United States 29A Marine, line 10
11 Ratio:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Underwriting profit — all classes, item 9
12 Federal income tax on 2011 U.S. 29A Marine Business return. Obtain as follows: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
If ratio in line 11 is less than 100%, apply said ratio to line 8.
If ratio in line 11 exceeds 100%, the following ratio is to be applied to line 8:
Underwriting profit — United States 29A Marine, line 10
Sum of underwriting gains of all classes showing gains in Expense Exhibit. Part II
Ocean Marine Underwriting Profit Per Expense Exhibit
Complete the following schedule. The ocean marine underwriting profit as reported in the insurance expense exhibit is to be allocated to alien and United
States with no adjustment in the latter for exclusion of prior losses. Give percentages that losses incurred and expenses incurred bear to earned premiums.
– Foreign –
– United States –
Net earned premiums . . . . . . . . . . . . . . .
Pct.
Pct.
Net losses incurred . . . . . . . . . . . . . . . . .
Net expenses incurred . . . . . . . . . . . . . .
Underwriting profit. . . . . . . . . . . . . . . . . .
Foreign
United States
Profit Schedule
11 Net premiums on marine insurance written in the United States during the taxable year, meaning gross premiums less
return premiums, premiums on policies not taken and net premiums paid for reinsurance (from Supplementary Schedule,
line 5, col. d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
12 Subtract unearned premiums on such marine insurance at end of taxable year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2
13 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3
14 Add unearned premiums on such marine insurance at the beginning of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4
15 Net earned premiums on United States 29A marine insurance for taxable year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5
16 Subtract net losses incurred (from Net Loss Schedule, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6
17 Subtract net expenses incurred (from Supplementary Schedule, line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
18 Subtract dividends paid or credited to policyholders (from Dividend Deduction Schedule, line 5) . . . . . . . . . . . . . . . . . . . . . . . 3 8
19 Balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
10 Subtract federal income tax (from Dividend Deduction Schedule, line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10
11 Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 11
12 Add excess of total of lines 7 and 10 over 40% of net premiums (from line 1). Not less than “0”. . . . . . . . . . . . . . . . . . . . . . . 3 12
13 Net underwriting profit on United States 29A Marine taxable year 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 13

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