Wis. Admin. Code Office of the Commissioner of Insurance § 2

Current through May 28, 2024
Appendix 2 - PREMIUM TAX REPORT

Year Ending December 31, 2

Directly Placed Unauthorized Insurance - Sections 618.42 and 618.43, Wisconsin Statutes

This report is to be filed with the Commissioner of Insurance, State of Wisconsin, Madison, Wisconsin 53702, on or before March 1, 2

Person or Organization Insured

Address, including zip code

Date

Contract Number (1)

Effective Date (2)

Expiration Date (3)

Name and Address of Insurance Company (4)

Description or Type of Coverage (5)

Premium Charged (6)

3% Tax on Premium* (7)

*1/2 of 1% for Ocean Marine Insurance

Premium Charged- Total Column (6) ...

...................

$ _________

Tax Due @ 3%*- Total Column (7) ...

...................

$ _____________

Amount Enclosed ...

...................

$ ___________

The undersigned certifies that this report is true and correct according to the best of his or her information, knowledge, and belief.

_______________________

_____________, 2 ______

Wis. Admin. Code Office of the Commissioner of Insurance § 2

Amended by, Register December 2017 No. 744, eff. 1/1/2018

2011 Wisconsin Act 224 changed the tax rate for surplus lines insurance which is ocean marine insurance to the same 3% rate for all other surplus lines insurance. Any previous reference to a ½ of 1% rate for ocean marine insurance in this rule is not enforceable as that insurance is now taxed at the same 3% rate for all surplus lines insurance.