State Form 38337 PDF Details

The State 38337 form, serving as a Quarterly Statement of Estimated Premium and Associated Tax, plays a critical role for insurance companies operating in Indiana. Approved by the State Board of Accounts in 1987, this document outlines the necessary procedures for reporting and remitting estimated quarterly taxes on insurance premiums collected. Companies are required to submit this form with typewritten entries, rounding all dollar amounts to the nearest whole number, ensuring accuracy and uniformity. Each quarterly payment and associated form must be sent to the Indiana Department of Insurance's designated Bank Lockbox, adhering to strict deadlines set for April 15, June 15, September 15, and December 15. In instances where these dates fall on weekends or holidays, the due date adjusts to the preceding business day. The form specifies acceptable delivery methods, including various United States Postal Service options, to standardize the submission process. Detailed instructions guide insurers through calculating their estimated premium tax installment based on prior year figures or a projected 80% of current year premiums and associated taxes, accounting for any overpayments and interest on late payments. This meticulous process ensures compliance with Indiana statutes, including sections 27-1-18-2 and 27-1-20-12, underscoring the form's significance in maintaining the integrity of the state's insurance tax collection efforts.

QuestionAnswer
Form NameState Form 38337
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesQuarterly_Estim ated_Tax_Return state of indiana quarterly premium tax form

Form Preview Example

QUARTERLY STATEMENT OF ESTIMATED PREMIUM AND ASSOCIATED TAX

State Form 38337 (R/11/08)

Approved by the State Board of Accounts 1987

Make check payable: Indiana Department of Insurance

Send remittance with form to:

Indiana Department of Insurance

Bank Lockbox

P.O. Box 577

Indianapolis, IN 46206-0577

INSTRUCTIONS:

1.Must be typewritten.

2.All values must be rounded to the nearest dollar amount.

3.Send separate checks and forms for each company, to the above address; no other address is acceptable.

4.Must be received at the instructed address no later than the date due.

5.Quarterly Estimated Tax Payments and forms are to be received by April 15, June 15, Sept. 15 and Dec. 15

6.When the due date falls on a weekend or holiday the filing is due on the preceding business day.

7.U.S. Postal Express, U.S. Priority Mail, Certified U.S. Mail and regular U.S. mail are the only methods acceptable.

QUARTERLY STATEMENT OF ESTIMATED PREMIUM AND ASSOCIATED TAX FOR QUARTER ENDING ______________________, 20______

State of Incorporation

 

 

NAIC Number (5 digit)

 

 

 

 

 

Name of Insurer

 

 

 

 

 

 

 

 

 

Contact Address (Street, City, State and Zip Code)

 

 

 

 

 

 

 

Contact Person/Title or Position

Contact Phone

Contact Person’s Email Address

 

 

(

)

 

 

 

 

 

 

 

1. Basis for Estimates:

 

 

 

 

(A) Total Indiana Premium and Associated Tax paid for business written during

the prior calendar year

$

2. Estimated Premium Tax installment due, must be at least:

 

 

 

 

(A)

One-fourth of the total Indiana Premium and Associated Tax paid for business written during the

 

 

previous calendar year (1/4 of Line 1A) or

 

 

 

$

(B)

One-fourth of 80% of actual premium and associated tax for the current year

 

 

$

 

 

 

 

 

3. Composition of Premium Tax Payment:

 

 

 

 

(A) Amount of Payment – Item 2 (A) or (B) above

 

 

 

$

(B) Less: Prior Year Overpayment (if applicable)

 

 

 

 

 

Report up to amount of tax due, do not exceed tax liability.

 

 

 

$

(C) Net Premium Tax Payment (3A less 3B)

 

 

 

$

 

 

 

 

 

(D)

Late Payment: Include 1% interest per calendar month, or part thereof

 

 

 

 

 

Please include interest payment, to avoid incurring additional interest.

 

 

 

$

4. Total Payment Remitted (sum of: 3C and 3D)

 

 

 

 

(If amount is less than zero; enter zero)

 

 

 

$

I certify that the above estimated quarterly premium tax payment has been calculated in accordance with the provisions of Indiana Statutes, Section 27-1-18- 2, 27-1-20-12, and to the best of my knowledge and belief this is a true, correct and complete statement of premium and associated tax due.

Typed or Printed Name of Preparer:

Title of Preparer:

Typed or Printed Name of Authorized Officer:

Title of Officer:

Signature of Authorized Officer:

 

Date Signed (MM,DD,YY):

 

 

 

 

FOR INSURANCE DEPARTMENT USE ONLY

 

BATCH #

DATE

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In an effort to finalize this document, be certain to provide the right information in every field:

1. Fill out your State Form 38337 with a group of necessary blanks. Collect all of the necessary information and ensure not a single thing forgotten!

State Form 38337 conclusion process described (stage 1)

2. When this part is done, go to enter the relevant information in these: Total Payment Remitted sum of C, FOR INSURANCE DEPARTMENT USE ONLY, and BATCH DATE.

Writing section 2 in State Form 38337

As for Total Payment Remitted sum of C and FOR INSURANCE DEPARTMENT USE ONLY, be certain you get them right in this current part. Those two are the most significant ones in this file.

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