Form 207 - Insurance Premium Tax Return For Domestic Companies
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1
2STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
INSURANCE PREMIUM TAX RETURN FOR DOMESTIC COMPANIES
(Rev. 12/98)
1.
Due Date: This return must be filed on or before March 1 following the close of the calendar year. If the due date
falls on a Saturday, Sunday or a legal holiday, the next business day is the due date.
2.
A copy of Schedule T and the Connecticut business page from the Annual Statement to the Insurance
Department must accompany this return.
3.
If this is an amended return, enter the calendar year of the return which you are amending: ______________ .
Connecticut Tax Registration Number
For Calendar Year
Date Received (For Department Use Only)
Federal Employer Identification Number
1. Gross direct premiums (less returned premiums, including cancellations) received during the above
calendar year from policies written on property or risks located or resident in this state, but excluding
annuity considerations and premiums received for reinsurance assumed from other companies
1
2. Dividends paid to policy holders on direct business, not including any dividends paid on account of
the ownership of stock
2
3. Taxable premiums (Subtract Line 2 from Line 1)
3
4. Tax: Multiply Line 3 by 1.75% (.0175)
4
5. Connecticut Life and Health Insurance Guaranty Association Credit
(50% of assessments paid during the above calendar year)
5
6. Corporation Business Tax Credit (80% of tax paid less tax refunded during the calendar year by a
qualifying local domestic insurance company)
6
7. Insurance Department Assessment Credit (80% of the assessment paid under Conn. Gen. Stat. §38a-48
during the calendar year by a qualifying local domestic insurance company)
7
8. All other Connecticut Business Tax credits (Attach Form CT-1120K)
8
9. Total credits (Add Lines 5, 6, 7 and 8)
9
10. Net tax (Subtract Line 9 from Line 4. If negative figure, enter a zero)
10
11. Overpayment from prior year
11
12. Payments made with estimated tax payment coupons (FORMS 207 ESA, ESB, ESC and ESD)
12
13. Payments made with extension request (Form 207/207F EXT)
13
14. Total prior payments (Add Lines 11, 12 and 13)
14
15. Balance of tax due (overpaid) (Subtract Line 14 from Line 10)
15
16. If late: penalty (16a)
$ ______________ plus interest (16b)
$ _______________
=
16
17. Interest on underpayment of estimated tax (Form 207 I)
17
18. Amount to be credited to an estimated return (18a)
$ ____________ refunded (18b)
$ ____________ =
18
19. Balance due with this return (Make check payable to: Commissioner of Revenue Services)
19
TAXPAYER MUST SIGN DECLARATION ON REVERSE
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