Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 6 - General
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_____
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Agent |
Business address, including zip code |
Date |
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|
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 ......................... |
$____________ |
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|
** 1/2 of 1% for Ocean Marine Insurance |
Tax Due @ 3%**-Total Column (7) ..................... |
$ _____________ |
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|
Amount Enclosed ................ |
$ ______________ |
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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.
