Form 207f - Insurance Premiums Tax Return Nonresident And Foreign Companies - 2001
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1
22001
Department of Revenue Services
Form 207F
State of Connecticut
PO Box 2990
Insurance Premiums Tax Return
Hartford CT 06104-2990
Nonresident and Foreign Companies
(Rev. 12/01)
Purpose - Each nonresident or foreign insurance company authorized to do an insurance business in Connecticut must file this return on or before
March 1, 2002, to report its insurance premiums tax liability for calendar year 2001.
A copy of Schedule T and the Connecticut business page from the Annual Statement filed with the Insurance Department must
accompany this return.
CT Insurance Premiums Tax Registration No.
Date Received (For Department Use Only)
Federal Employer Identification Number
Organized Under the Laws of
Check if this is an amended return.
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 policyholders on direct business, not including any dividends paid on account of the ownership of
stock
2
3 Net direct premiums received during the above calendar year from ocean marine insurance policies written on
property located in this state
3
4 Benefit payments from group health insurance premiums to the extent allowed by Conn. Gen. Stat. §12-210a
4
5 Total deductions (Add Lines 2, 3, and 4)
5
6 Taxable premiums (Subtract Line 5 from Line 1)
6
7 Multiply Line 6 by 1.75% (.0175)
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8 Taxes and other obligations on retaliatory basis (See instructions on reverse side)
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9 Other obligations paid to Connecticut (See instructions on reverse side)
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10
Retaliatory computations (Subtract Line 9 from Line 8)
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11 Tax (Enter Line 7 or Line 10, whichever is greater)
11
CIGA and CLHIGA assessment credits (Attach Schedule GAA)
12
12
13
Other Connecticut business tax credits (See instructions on reverse side)
13
14
Total credits (Add Line 12 and Line 13)
14
15
Subtract Line 14 from Line 11. (If less than zero, enter zero.)
15
16
Overpayment applied from prior year
16
17
Payments made with estimated tax payment coupons (Forms 207F ESA, ESB, ESC, and ESD)
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18
Payments made with extension request (Form 207/207F EXT)
18
Total prior payments (Add Lines 16, 17, and 18)
19
19
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Balance of tax due (overpaid) (Subtract Line 19 from Line 15)
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21
If late: penalty (21a) $ ___________________
plus interest (21b) $ __________________ ( See instructions ) =
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I I I I I )
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Interest on underpayment of estimated tax ( Attach Form 207
22
23
Amount to be credited to 2002 estimated tax (23a) $ ________________ refunded (23b) $ _____________
=
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24
Balance due with this return (Make check payable to: Commissioner of Revenue Services)
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TAXPAYER MUST SIGN DECLARATION ON REVERSE SIDE
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