Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 6 - General
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 |
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|
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) ... |
................... |
$ _________ |
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|
Tax Due @ 3%*- Total Column (7) ... |
................... |
$ _____________ |
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|
Amount Enclosed ... |
................... |
$ ___________ |
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The undersigned certifies that this report is true and correct according to the best of his or her information, knowledge, and belief. |
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_______________________ _____________, 2 ______ |
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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.
