Wis. Admin. Code Office of the Commissioner of Insurance, ch. Ins 6, app 2
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, ch. Ins 6, app 2
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 1/2 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.