Free CT-33-NL - New York

Staple forms here

CT-33-NL
Amended return
Employer identification number (EIN)

New York State Department of Taxation and Finance

Non-Life Insurance Corporation Franchise Tax Return
Tax Law -- Article 33
All filers must enter tax period: beginning
File number Business telephone number

ending
If you claim an overpayment, mark an X in the box

(
Legal name of corporation

)
Trade name/DBA State or country of incorporation

Mailing name (if different from legal name above)

Date received (for Tax Department use only)

c/o
Number and street or PO box Date of incorporation

City

State

ZIP code

Foreign corporations: date began business in NYS

NAICS business code number (see instructions)

If address above is new, mark an X in the box

Principal business activity

If your name, employer identification number, address, Audit (for Tax Department use only) or owner/officer information has changed, you must file Form DTF95. If only your address has changed, you may file Form DTF96. You can get these forms from our Web site, or by fax or phone. See Need help? in the instructions.

Metropolitan transportation business tax (MTA surcharge) -- During the tax year did you do business, employ capital, own or lease property, or maintain an office in the Metropolitan Commuter Transportation District? Mark an X in the appropriate box. If Yes, you must file Form CT33M (see instructions) .............................................. Yes A. Pay amount shown on line 15. Make payable to: New York State Corporation Tax Attach your payment here. Detach all check stubs. (See instructions for details.) B. Federal return filed: (mark an X in one box) Form 1120L Form 1120PC Consolidated basis Other: A.

No

Payment enclosed

Have you been audited by the Internal Revenue Service in the past 5 years? .............................................. Yes If Yes, list years:

No

Enter primary corporation name and EIN
(if a member of an affiliated federal group):

Name

EIN

Enter parent corporation name and EIN
(if more than 50% owned by another corporation):

Name

EIN

Attach a copy of your Annual Report of Premiums and Exhibit of Premiums and Losses (New York) as filed with the New York State Insurance Department, and copies of the following schedules from your Annual Statement: Exhibit of Premiums Written, Schedule T; Schedule F, Reinsurance, Parts 1 and 3; and Underwriting and Investment Exhibit, Part 2B - Premiums Written.

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Computation of tax and installment payments of estimated tax (see instructions)
1 Accident and health insurance premiums from line 34 ........ × .0175 2 Other nonlife insurance company premiums from line 35... × .02 3 Total tax on premiums (add lines 1 and 2) ......................................................................................... 4 Minimum tax...................................................................................................................................... 5 Tax due before credits (line 3 or line 4 amount, whichever is greater) ................................................... 6 Tax credits (enter amount from line 47) ............................................................................................... 7 Tax due (subtract line 6 from line 5) .................................................................................................... First installment of estimated tax for next period: 8a If you filed a request for extension, enter amount from Form CT5, line 2 ...................................... 8b If you did not file Form CT5 and line 7 is over $1,000, see instructions ......................................... 9 Total (add line 7 and line 8a or 8b) ........................................................................................................ 10 Total prepayments from line 46 ....................................................................................................... 11 Balance (if line 10 is less than line 9, subtract line 10 from line 9) ............................................................. 12 Estimated tax penalty (see instructions; mark an X in the box if Form CT-222 is attached) ............... 13 Interest on late payment (see instructions) ........................................................................................ 14 Late filing and late payment penalties (see instructions) ................................................................... 15 Balance due (add lines 11 through 14 and enter here; enter the payment amount on line A on page 1) ..... 16 Overpayment (if line 9 is less than line 10, subtract line 9 from line 10) ................................................... 17 Amount of overpayment to be credited to next period .................................................................... 18 Balance of overpayment (subtract line 17 from line 16) ...................................................................... 19 Amount of overpayment to be credited to Form CT33M ............................................................... 20 Refund of overpayment (subtract line 19 from line 18) ........................................................................ 21a Refund of tax credits (see instructions) ............................................................................................. 21b Tax credits to be credited as an overpayment to next year's return (see instructions) ...................... 22 Issuer's allocation percentage from line 38 ..................................................................................... 23 Reinsurance allocation percentage from line 33 ............................................................................. attach separate sheet if necessary)
A Name of ceding company B Reinsurance premiums received C Reinsurance allocation % D Reinsurance premiums allocated to New York State
(column B × column C)

1. 2. 3. 4. 5. 6. 7. 8a. 8b. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21a. 21b. 22. 23.

250 00

% %

Schedule A -- Allocation of reinsurance premiums when location of risks cannot be determined (see instructions;

Totals from attached sheet ............................................ 24 Total (add column D amounts; enter here and include on line 28) ..............................................

24.

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Schedule B -- Computation of reinsurance allocation percentage (see instructions)
25 26 27 28 29 30 31 32 33 New York taxable premiums ...................................................................... 25. New York ocean marine premiums............................................................ 26. New York premiums for annuity contracts and insurance for the elderly ... 27. New York premiums on reinsurance assumed (see instructions) ................ 28. Total New York gross premiums (add lines 25 through 28) ........................... 29. New York premiums ceded that are included on line 29 ........................... 30. Total New York premiums (subtract line 30 from line 29) ............................... 31. Total premiums.......................................................................................... 32. Reinsurance allocation percentage (divide line 31 by line 32; enter here and on line 23) .......................

33.

%

Schedule C -- Computation of taxable premiums (see instructions)
34 Accident and health insurance premiums (enter here and in the first box on line 1) ............................... 34. 35 Other nonlife insurance premiums (enter here and in the first box on line 2) ........................................ 35.

Schedule D -- Computation of issuer's allocation percentage (see instructions)
36 New York gross direct premiums ..................................................................................................... 37 Total gross direct premiums ............................................................................................................ 38 Issuer's allocation percentage (divide line 36 by line 37; enter here and on line 22) .............................. 36. 37. 38.

%

Composition of prepayments (see instructions)
39 40 41 42 43 44 45 46 Date paid Mandatory first installment ........................................................................................ 39. Second installment from Form CT400...................................................................... 40. Third installment from Form CT400 ......................................................................... 41. Fourth installment from Form CT400 ....................................................................... 42. Payment with extension request from Form CT5, line 5 ........................................... 43. Overpayment credited from prior years ............................................................................................ 44. Overpayment credited from Form CT33M Period ...................................................... 45. Total prepayments (add lines 39 through 45; enter here and on line 10) ................................................... 46. Amount

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Summary of tax credits claimed against current year's franchise tax (see instructions; attach applicable credit forms)
Fire insurance premiums tax credit (enter amount claimed) ......................... Form CT33R Retaliatory tax credits ........................ Form CT33.1 CAPCO credit ......................................... Form CT41 Credit for employment of persons with disabilities ....................... Form CT43 Special additional mortgage recording tax credit ............................... Form CT44 Investment tax credit for the financial services industry .................... Form CT249 Longterm care insurance credit ........ Form CT250 Defibrillator credit............................... Form CT259 Fuel cell electric generating equipment credit ................................ Form CT601 EZ wage tax credit ............................. Other credits ...................................... 47 Total tax credits claimed above (enter here and on line 6) .................................................................. 48 Total tax credits claimed above that are refund eligible (see instructions) ..........................................
Designee's name (print) Third ­ party Yes No designee Designee's e-mail address (see instructions)

Form CT601.1 ZEA wage tax credit .......................... Form CT602 EZ capital tax credit ........................... Form CT604 QEZE tax reduction credit ................. Form CT606 QEZE credit for real property taxes ... Form CT611 Brownfield redevelopment tax credit ... Form CT612 Remediated brownfield credit for real property taxes ............................ Form CT613 Environmental remediation insurance credit ................................. Form CT631 Security officer training tax credit ...... Form DTF624 Lowincome housing credit ............... Form DTF630 Green building credit .........................

47. 48.
Designee's phone number ( )

PIN
Official title Date ID number Address City State Date ZIP code

Certification: I certify that this return and any attachments are to the best of my knowledge and belief true, correct, and complete. Authorized person Paid preparer use only
Signature of authorized person E-mail address of authorized person

Firm's name (or yours if self-employed) Signature of individual preparing this return E-mail address of individual preparing this return

See instructions for where to file.

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