2014 Premium Tax Vehicle Final (Form 303)
Transcription
2014 Premium Tax Vehicle Final (Form 303)
CALENDAR YEAR 2014 PREMIUM TAX FINAL FOR VEHICLE COMPANIES Office of Superintendent of Insurance, 1120 Paseo De Peralta Room 433, Santa Fe, NM 87501, P.O. Box 1689 Room 433, Santa Fe, NM 87504-1689 Make check payable to “Office of Superintendent of Insurance” For calendar year ending December 31, 2014. Due April 15, 2015. Late, unsigned and/or incomplete reports will be assessed a penalty pursuant to NMSA 1978, Section 59A-6-4. Company Name: ___________________________________________________ Company Address: _________________________________________________ _________________________________________________ Contact: _____________________________________________ Phone/Email: _____________________________________________ CLASS 1. Premiums written from policies within the State of New Mexico as per NM State Business page NM Co. # __________ Class: ___________ NAIC: __________ AMENDED, Reason:_________________________ Name or address change (Submit address change form) DEDUCTIONS ALLLOWED: Supporting Documents Required 2.Political Subdivisions (MUST ATTACH BREAKDOWN) 3. Dividends paid/credited to policyholders (Applies to Reinsurance ONLY) 4. Premiums received from Authorized companies for reinsurance on NM risks. 5. Net Premiums on which the New Mexico tax is based. (19.1) Pvt. Passengers Auto No Fault – Personal Injury Protection (19.2) Other Pvt. Passenger Auto Liability (19.3) Commercial Auto No Fault – Personal Injury Protection (19.4) Other Commercial Auto Liability (21.1) Pvt. Passenger AutoPhysical Damage (21.2) Commercial AutoPhysical Damage (22) Aircraft (All Perils) Miscellaneous 1.TOTALS 2. Premium Tax Due (3.003% of Line 1, Column 5) 3. Less 1st and 2nd 2014 quarterly taxes paid (include credit taken) 4. Less 3rd and 4th 2014 quarterly taxes paid (include credit taken) 5. Less year 2013 remaining credit not used in line 3 & 4 6. Net Premium Tax Due #78 Total Amount of Check Check # The signature for the Authorized Preparer means that: 1) The Authorized Preparer is authorized by the company’s Board of Directors to prepare this report. 2) The Authorized Preparer has examined this report. 3) The contents of this report are true and correct to the best of the Authorized Preparer’s knowledge. NOTARY SEAL ____________________________ President/Authorized Signature _____________________________ Secretary/Treasurer/Authorized Signature Notary Signature _____________________ My Commission Expires _______________ Subscribed and sworn before me this _____ day of _______, 20___ Postmarked _______ Initials _________ Form 303 Updated March 11, 2015