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

Current through May 28, 2024
Appendix 2 - REPORT OF SURPLUS LINES INSURANCE

Year Ending December 31, 2

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

Agent

Business address, including zip code

Date

Proposal No. and

Date*

(1)

Name

of Insured

(2)

Name of Insurance

Company

(3)

Contract

Number

(4)

Term and Effective Date (5)

Premium Charged (6)

3%**

Premium Tax

Collected

(7)

*Proposals are to be numbered consecutively

. Premium Collected During Year .........................

$____________

** ½ of 1% for Ocean Marine Insurance

Tax Due @ 3%**-Total

Column (7) .....................

$ _____________

Amount Enclosed ................

$ ______________

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