Form IB-13 "Gross Premiums Tax Return - Life, Accident, Health and Title Companies" - North Carolina

What Is Form IB-13?

This is a legal form that was released by the North Carolina Department of Revenue - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the North Carolina Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form IB-13 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form IB-13 "Gross Premiums Tax Return - Life, Accident, Health and Title Companies" - North Carolina

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CAROLINA
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..............
•·
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m
u:
==
=
===
=
Do Not Include This Page
·-·
N C
D(i)
R
-
I
•• · ··=!!! ::: ! : •
NORTH
::::
.
CAROLINA
DEPARTMENT
OF REVENUE
Instructions
For Handwritten
Forms
Before
Guidelines
Sending
Printing
Do not use red ink.
ocopies of returns.
Use blue or black ink.
Submit originals only.
,,___(8)
®
Do not mix form types.
Do not use dollar
Set page scaling to
signs, commas, or
"none." The Auto-Rotate
other punctuation
and Center checkbox
marks.
should be unchecked.
,
t®I
1�
1
Do not select "print on
c;
both sides of paper."
;
1
IB-13
Gross Premiums Tax Return
Web
Life, Accident, Health and Title Companies
1-21
DOR Use Only
For tax year beginning
and ending
(MM-DD-YY)
(MM-DD-YY)
Legal Name (First 35 Characters)
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Mailing Address
Federal Employer ID Number
City
State
Zip Code
Name of Contact Person
Phone Number
State of Domicile
NAIC Number
Fill in circle if applicable:
Payment has been made through electronic funds transfer (EFT)
Amended Return
Date of Withdrawal if Company Surrendered Certificate of Authority to do Business in NC During the Year
Schedule A. Summary of Amount Due
,
,
,
.
Total 2020 Gross Premiums Tax Liability Due
1.
00
1.
(From Schedule B, Part 3, Line 10)
,
,
,
.
Total 2020 Insurance Regulatory Charge Due
2.
00
2.
(From Schedule C, Line 7)
,
,
,
.
Total Payment Due for 2020
$
3.
$
3.
00
Add Line 1 and Line 2
The following must be attached to this return:
2020 Schedule T from the Annual Statement
2020 North Carolina Business Page
The following must be attached if applicable (check all that apply):
Reconciliation schedule explaining any differences in the premiums listed on the tax return, the North Carolina
Business Page, and Schedule T
2020 Guaranty Assessment Tax Credit Available notice from either the North Carolina Life & Health Insurance
Guaranty Association or the North Carolina Insurance Guaranty Association
Schedule in support of any supplemental workers’ compensation tax credits claimed
Form CD-425, NC-478 and applicable series schedules in support of tax credits claimed
Printed Name:
Title:
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
Returns are due by the 15th day of the 3rd month following the end of the calendar year. Your check or money
order must be in the form of U.S. currency from a domestic bank. Electronic filing of returns is not available.
N.C. Department of Revenue, Insurance Premiums Tax Unit, P.O. Box 25000, Raleigh, NC 27640-0300
Legal Name
FEIN
Page 2, Form IB-13, Web, 1-21
Schedule B. Calculation of Gross Premiums Tax
Part 1. North Carolina Basis Gross Premiums Tax
(Multiply NC Taxable Premiums by the Applicable Tax Rate)
NC Taxable Premiums
Tax Rate
Tax Computed on NC Basis
,
,
,
.
,
,
,
.
00
00
1.
Life Insurance
1.9%
,
,
,
.
,
,
,
.
2.
Annuities
00
00
0%
,
,
,
.
,
,
,
.
3.
Accident and Health
00
00
1.9%
,
,
,
.
,
,
,
.
00
00
4.
Workers’ Comp
2.5%
,
,
,
.
,
,
,
.
5.
All Other Lines (attach schedule)
00
00
1.9%
,
,
,
.
,
,
,
.
6.
Finance Charges
00
00
1.9%
,
,
,
.
,
,
,
.
7.
Total
00
00
Add Lines 1 through 6
Part 2.
State of Domicile Basis Gross Premiums Tax
(Enter state of domicile tax rate in the Tax Rate column. Multiply NC Taxable Premiums
by the Tax Rate. Attach supplemental schedule showing detail of taxable premiums and tax computation if space provided is inadequate.)
NC Taxable Premiums
Tax Rate
Tax Computed on State of Domicile Basis
,
,
,
.
,
,
,
.
1.
Life Insurance
00
00
%
,
,
,
.
,
,
,
.
2.
Annuities
00
00
%
,
,
,
.
,
,
,
.
3.
Accident and Health
00
00
%
,
,
,
,
,
,
.
.
4.
Workers’ Comp
00
00
%
,
,
,
.
,
,
,
.
5.
All Other Lines (attach schedule)
00
00
%
,
,
,
.
,
,
,
.
6.
Finance Charges
00
00
%
,
,
,
.
,
,
,
.
7.
Total
00
00
Add Lines 1 through 6
Part 3.
Computation of Gross Premiums Tax
,
,
,
.
1. Gross Premiums Tax Computed on NC Basis
00
1.
(From Part 1,Total Tax Computed)
,
,
,
.
2. Retaliatory Tax
00
2.
Part 2, Total Tax Computed minus Part 1, Total Tax Computed, but not less than zero.
,
,
,
.
3. Gross Premiums Tax
00
3.
Line 1 plus Line 2
,
,
,
.
4. Tax Credits
00
4a.
a. NC Guaranty Fund Assessment Credit (From Schedule E, Total; not to exceed Line 3)
,
,
,
.
b. CD-425 and NC-478 Tax Credits (Attach applicable forms)
00
4b.
,
,
,
.
5. Gross Premiums Tax Liability
00
5.
Line 3 minus Lines 4a and 4b, but not less than zero
,
,
,
.
6. Prior Year Credit Applied to 2020
6.
00
(From Schedule D, Line 1, Column 1)
,
,
,
.
7. Gross Premiums Tax Installment Payments
7.
00
(From Schedule D, Line 5, Column 1)
,
,
,
.
8. Balance of Gross Premiums Tax Due
00
8.
Line 5 minus Lines 6 and 7, but not less than zero. If less than zero, enter amount on Line 11.
,
.
,
.
(See www.ncdor.gov for current
9. a. Penalties
b. Interest
00
00
interest rate and penalty information)
,
,
,
.
$
00
10. Total Gross Premiums Tax Due
10.
Add Lines 8, 9a and 9b
,
,
,
.
11. Overpayment
00
11.
Legal Name
FEIN
Page 3, Form IB-13, Web, 1-21
Part 3.
Computation of Gross Premiums Tax
(continued)
,
,
,
.
12.
Amount of Line 11 to be Applied to 2021 Gross Premiums Tax
12.
00
,
,
,
.
13. Gross Premiums Tax to be Refunded
13.
00
Line 11 minus Line 12
Schedule C. Insurance Regulatory Charge
,
,
,
.
1. Gross Premiums Tax Liability
00
1.
(From Schedule B, Part 1, Total Tax Computed)
,
,
,
.
2. Insurance Regulatory Charge
00
2.
Multiply Line 1 by 6.5%
,
,
,
.
3. Prior Year Credit Applied to 2020
00
3.
(From Schedule D, Line 1, Column 2)
,
,
,
.
4. Insurance Regulatory Charge Installment Payments
4.
00
(From Schedule D, Line 5, Column 2)
,
,
,
.
5. Balance of Insurance Regulatory Charge Due
5.
00
Line 2 minus Lines 3 and 4, but not less than zero. If less than zero, enter amount on Line 8.
,
.
,
.
(See www.ncdor.gov for current
6. a. Penalties
b. Interest
00
00
interest rate and penalty information)
,
,
,
.
$
00
7. Total Insurance Regulatory Charge Due
7.
Add Lines 5, 6a and 6b
,
,
,
.
8.
00
8. Overpayment
,
,
,
.
00
9. Amount of Line 8 to be Applied to 2021 Insurance Regulatory Charge
9.
,
,
,
.
10. Insurance Regulatory Charge to be Refunded
00
10.
Line 8 minus Line 9
Schedule D. Installment Payments Made
(Do not include any negative amounts or amounts from Line 1 on Lines 2-4)
(1) Gross Premiums Tax
(2) Insurance Regulatory Charge
1.
Prior Year Credit Applied to 2020
(Gross Premiums Tax - from prior IB-13, Sch. B, Part 3, Line 12)
(Insurance Regulatory Charge - from prior IB-13, Sch. C, Line 9)
2. Installment Payment made April 15, 2020
(Gross Premiums Tax - from IB-14, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-14, Part 2, Line 10)
3. Installment Payment made June 15, 2020
(Gross Premiums Tax - from IB-14, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-14, Part 2, Line 10)
4.
Installment Payment made October 15, 2020
(Gross Premiums Tax - from IB-14, Part 1, Line 4)
(Insurance Regulatory Charge - from IB-14, Part 2, Line 10)
5.
Total Installment Payments Made in 2020
Add Lines 2 through 4
Schedule E. Guaranty Association Credit Available
Assessment Amount
Percentage
Amount of Credit
1.
Assessment Year 2015
20%
2.
Assessment Year 2016
20%
3.
Assessment Year 2017
20%
4.
Assessment Year 2018
20%
5.
Assessment Year 2019
20%
Total
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