Rhode Island Declaration of Surplus Line Brokers Estimated Tax - For T-71A

Declaration of Surplus Line Brokers Estimated Tax - For T-71A
SLB-EST_Layout 1
State of Rhode Island and Providence Plantations

Form SLB-EST
Surplus Lines Broker Estimated Payment Form
Name

Federal employer identification number

Address

For the period ending:

Address 2

City, town or post office

State

ZIP code

E-mail address

INSTRUCTIONS
1. Every surplus lines broker liable for the gross premiums tax shall file a declaration of its estimated tax for the calendar
year if its estimated tax for such taxable year can reasonably be expected to exceed $500.00. The entire amount of
such estimated tax shall constitute the amount of advance required to be paid.
2. The amounts and due dates of the installments are as follows:
--> 25% of the calendar year tax by April 30th
--> 50% of the calendar year tax by June 30th
--> 75% of the calendar year tax by October 31st
--> 100% of the calendar year tax by December 31st
3. Every surplus lines broker is subject to an assessment of 18% per annum for underpayments and penalties for the
willful neglect or failure to file a declaration or pay any installment due thereunder.
4. When there is not an increase in the tax rate from one year to the next, no interest or penalty will occur for underestimated
tax payment, if prepayments are made equal to the prior year’s tax.
5. Mail voucher and payment to:

RI Division of Taxation
One Capitol Hill - Suite 9
Providence, RI 02908-5811

Payments can be made online. For more information, visit: https://www.ri.gov/taxation/business/index.php
If your estimate is zero or you make your payment online, you do not need to send in this estimated tax form.

Amount due with estimate
1

Total tax from prior year...........................................................................................................

1

2

Estimated tax due for the current year.....................................................................................

2

3

Estimated tax payment due. Multiply line 2 by the applicable percentage. (25% for first
estimate, 50% for second estimate, 75% for third estimate, 100% for fourth estimate)..........

3

4

Overpayment from prior year being applied to this payment plus any amounts paid to date..

4

5

Amount due with this estimate. Subtract line 4 from line 3.....................................................

5

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Authorized officer signature
Print name
Date
Telephone number

Paid preparer signature

Paid preparer address

Print name

City, town or post office

May the Division of Taxation contact your preparer? YES

Date

State

Telephone number

ZIP Code

Revised 10/2013

PTIN

Key  #13