Schedule 800b - Guaranty Fund Assessment Credit Worksheet - 2014
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1Schedule 800B
2014 GUARANTY FUND ASSESSMENT CREDIT WORKSHEET
Attach to Form 800. Submit copies of the worksheet if additional space is needed. Include totals of all worksheets on Line 16 of the worksheet. Do not submit blank form.
Name of Insurance Company
Federal ID Number
NAIC/License #
A
B
C
D
E
F
G
H
Guaranty Fund
Effective Federal
2014 FIT Benefit
2014 Insurance
Certificate
Certificate of
Allowable
Assessment
Income Tax Rate
Assessment
(applies if Yes
Premiums
of Contribu-
Contribution
Amortized Tax
Expensed on
(applies if Yes is
Notice Date
is checked in
License Tax
tion Date
Amount
Credit for 2014
Federal Income
checked in Column
Column E)
Credit
Statement
E)
1
Yes or
No
2
Yes or
No
3
Yes or
No
4
Yes or
No
5
Yes or
No
6
Yes or
No
7
Yes or
No
8
Yes or
No
9
Yes or
No
10
Yes or
No
11
Yes or
No
12
Yes or
No
13
Yes or
No
14
Yes or
No
15
Yes or
No
Total to be carried to Schedule 800CR.
16
Include totals of all worksheets ..........................
Enter on Schedule
Enter on Schedule
800CR, Line 27.
800CR, Line 29.
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