Indicate the calendar year that you are reporting on and complete your statement. We will email you a confirmation that includes a summary of the information you provide.
CALENDAR YEAR REPORTING ON
TOTAL OF GROSS DIRECT PREMIUMS
Less return premiums thereon, for policies or contracts of private passenger and commercial automobile bodily injury insurance. This amount should agree with the sum of NY Supplemental Insurance Exhibits lines 19.1, 19.2, 19.5 and 19.6.
Gross direct premiums less return premiums thereon, for policies or contracts of which evidence thereof has been filed under Section 370 of the Vehicle and Traffic Law.
Other state automobile bodily Injury risks reported to New York State for tax purposes only. (Do not enter amount on this line unless included in your Total Gross Direct Premiums reported above.)
FINAL TOTAL FOR ASSESSMENT
Final Total for Assessment Authorized by Section 137 and Section 363 of the Vehicle & Traffic Law.
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