"Insurance Companies - Installment" - Newfoundland and Labrador, Canada

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INSURANCE COMPANIES TAX
THIS PORTION IS YOUR WORKSHEET TO USE IN COMPLETING YOUR ATTACHED TAX RETURN
KEEP THIS WORKSHEET FOR YOUR RECORDS
SEE REVERSE FOR COMPLETION INSTRUCTIONS
TAX REMITTER
FOR THE PERIOD ENDING:
NUMBER:
TAX RETURN CALCULATION
AMOUNTS
1. Estimated Taxable Premiums For the Period**
2. Not Applicable
N/A
3. Not Applicable
N/A
4. Total Tax Due (5% of Line 1)
5. Add DEBIT BALANCE / Subtract CREDIT BALANCE
6. Not Applicable
N/A
7. Total Amount Enclosed
** Net of premiums on reinsurance ceded to the company by other companies
THE AMOUNTS CALCULATED IN THE ITEMS ABOVE MUST BE COPIED
TO YOUR ATTACHED TAX RETURN
COMPLETE SUPPORTING RECORDS MUST BE KEPT UNTIL THEIR DESTRUCTION HAS BEEN AUTHORIZED BY THE
NOTE:
MINISTER OF FINANCE. FAILURE TO KEEP SUCH RECORDS WILL RESULT IN PENALTIES BEING IMPOSED.
DETACH AND RETURN THE BOTTOM PORTION
INSURANCE COMPANIES TAX INSTALLMENT RETURN
(UNDER THE REVENUE ADMINISTRATION ACT)
Government of
Newfoundland and Labrador
ALL APPLICABLE SECTIONS MUST BE COMPLETED
PLEASE TYPE OR PRINT CLEARLY IN INK
Department of Finance
Int. charged at a rate of
% per day
RETURN DUE DATE:
TAX REMITTER NO.:
TAX REMITTER:
.
AMOUNTS
FOR THE PERIOD ENDING
1. Estimated Taxable Premiums For the Period**
2. Not Applicable
N/A
3. Not Applicable
N/A
IF BUSINESS HAS BEEN
4. Total Tax Due (5% of Line 1)
DISCONTINUED DURING THE
PERIOD, PLEASE SPECIFY
5. Add DEBIT BALANCE / Subtract CREDIT BALANCE
6. Not Applicable
N/A
YEAR
MONTH
DAY
7. Total Amount Enclosed
CERTIFICATION
These statements are hereby certified to be correct to the best of my knowledgeand belief of the undersigned. it is a serious offence to make false
statements on this return.
SIGNATURE OF AUTHORIZED SIGNING OFFICER:
TITLE:
AUTHORIZED SIGNING OFFICER (Please Print or Type):
DATE:
TELEPHONE NO. OF AUTHORIZED SIGNING OFFICER:
IC
INSURANCE COMPANIES TAX
THIS PORTION IS YOUR WORKSHEET TO USE IN COMPLETING YOUR ATTACHED TAX RETURN
KEEP THIS WORKSHEET FOR YOUR RECORDS
SEE REVERSE FOR COMPLETION INSTRUCTIONS
TAX REMITTER
FOR THE PERIOD ENDING:
NUMBER:
TAX RETURN CALCULATION
AMOUNTS
1. Estimated Taxable Premiums For the Period**
2. Not Applicable
N/A
3. Not Applicable
N/A
4. Total Tax Due (5% of Line 1)
5. Add DEBIT BALANCE / Subtract CREDIT BALANCE
6. Not Applicable
N/A
7. Total Amount Enclosed
** Net of premiums on reinsurance ceded to the company by other companies
THE AMOUNTS CALCULATED IN THE ITEMS ABOVE MUST BE COPIED
TO YOUR ATTACHED TAX RETURN
COMPLETE SUPPORTING RECORDS MUST BE KEPT UNTIL THEIR DESTRUCTION HAS BEEN AUTHORIZED BY THE
NOTE:
MINISTER OF FINANCE. FAILURE TO KEEP SUCH RECORDS WILL RESULT IN PENALTIES BEING IMPOSED.
DETACH AND RETURN THE BOTTOM PORTION
INSURANCE COMPANIES TAX INSTALLMENT RETURN
(UNDER THE REVENUE ADMINISTRATION ACT)
Government of
Newfoundland and Labrador
ALL APPLICABLE SECTIONS MUST BE COMPLETED
PLEASE TYPE OR PRINT CLEARLY IN INK
Department of Finance
Int. charged at a rate of
% per day
RETURN DUE DATE:
TAX REMITTER NO.:
TAX REMITTER:
.
AMOUNTS
FOR THE PERIOD ENDING
1. Estimated Taxable Premiums For the Period**
2. Not Applicable
N/A
3. Not Applicable
N/A
IF BUSINESS HAS BEEN
4. Total Tax Due (5% of Line 1)
DISCONTINUED DURING THE
PERIOD, PLEASE SPECIFY
5. Add DEBIT BALANCE / Subtract CREDIT BALANCE
6. Not Applicable
N/A
YEAR
MONTH
DAY
7. Total Amount Enclosed
CERTIFICATION
These statements are hereby certified to be correct to the best of my knowledgeand belief of the undersigned. it is a serious offence to make false
statements on this return.
SIGNATURE OF AUTHORIZED SIGNING OFFICER:
TITLE:
AUTHORIZED SIGNING OFFICER (Please Print or Type):
DATE:
TELEPHONE NO. OF AUTHORIZED SIGNING OFFICER:
IC
PLEASE READ CAREFULLY
A. Failure to file returns or remit the tax payable by the due date will result in interest and/or penalty being
imposed.
B. Cheques or money orders should be made payable to the Newfoundland Exchequer and forwarded to:
DEPARTMENT OF FINANCE
TAXATION AND FISCAL POLICY BRANCH
TAX ADMINISTRATION DIVISION
P.O. BOX 8720
ST. JOHN'S, NL
A1B 4K1
C. The tax return must be properly signed by an authorized officer, director, or agent of the business and filed
with the Minister no later than the due date shown on the front of this return.
D. Interest on outstanding balances is charged at a rate of
per day.
Where full payment is not made by the due date, an additional 10% of the amount due may be imposed.
E. Record your tax remitter number, name and tax program on the back of your cheque or money order.
F. If no tax due, a NIL return must be filed. Line 1 must always be completed.
G. If your business has been discontinued during the period:
[a] A return should be filed and the tax due remitted for the period.
[b] The name of the successor, if any, should be forwarded to the Minister of Finance, within 15 days, along
with your registration certificate for cancellation.
H. Any inquiries may be forwarded to (709) 729-6297 or toll free 1-877-729-1695.
DEPARTMENT OF FINANCE
TAXATION AND FISCAL POLICY BRANCH
TAX ADMINISTRATION DIVISION
P.O. BOX 8720
ST. JOHN'S, NL
A1B 4K1
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