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					                                      Territory Revenue Office           For help please phone
                                          Stamp Duty Act                 1300 305 353 for
                                                                         assistance.
                                      General Insurance Return


Postal Address:              GPO Box 154, Darwin NT 0801         Telephone: 1300 305 353
Office Location:             Level 4, 38 Cavenagh St Darwin NT   Facsimile: (08) 89995577
Website Address:             www.revenue.nt.gov.au               Email: ntrevenue.ntt@nt.gov.au


   Registration Number:
             Legal Entity:
                                           Territory Revenue Office                      For help please phone
                                               Stamp Duty Act                            1300 305 353 for
                                                                                         assistance.
                                           General Insurance Return


Postal Address:             GPO Box 154, Darwin NT 0801                         Telephone: 1300 305 353
Office Location:            Level 4, 38 Cavenagh St Darwin NT                   Facsimile: (08) 89995577
Website Address:            www.revenue.nt.gov.au                               Email: ntrevenue.ntt@nt.gov.au


                                                        Help

              Initialising your spreadsheet                         How to adjust your monthly returns
              Workbook protection                                   Problems & technical advice
              How to navigate around the spreadsheet                General information
              How to complete your monthly returns                  Guidance Notes


Initialising your spreadsheet: This spreadsheet will not operate unless you enter your "Registration
Number" and your business's "Legal Entity Name" in the WHITE cells at the top of the Main Page to the
Spreadsheet (click on the "Main Page" button above). You can then move your mouse button to select the
required function (ie. Main Page, Help or your monthly return). When your mouse pointer changes, click on
your mouse button and the function will open.

Workbook protection: This entire spreadsheet has been protected except for the WHITE cells to preserve
the formulae and calculations. If you try to update a cell that is protected, you will receive an error message
saying that "The cell or workbook you are trying to change is protected and therefore read-only". Press
enter or use your mouse to click "OK" to accept the message and use your directional keys on your
keyboard to move to a WHITE cell.

How to navigate around the spreadsheet: Throughout the spreadsheet are buttons and hyperlinks
(coloured blue - in help notes only) to allow you to quickly move to a particular area. To select a button or
hyperlink, point to it with your mouse and when the pointer changes to a pointed hand, click on it and you
will be taken to the function.

How to complete your monthly returns: Enter your details in the WHITE cells -
which are broken up into the following categories:
      *     Gross premiums received on every policy or renewal of a policy (including indemnity insurance
            policies from 1 July 2000)
      *     Duty on premiums refunded in respect of surrendered or cancelled policies
Once you have entered your monthly details, the spreadsheet will automatically calculate your duty payable
and update the worksheet with your year to date duty paid. You should then save the record, print the
return, detach the remittance advice slip and send it to this office with your payment. When you have
finished entering your data, you can use the navigational button to return to the Main Page.

How to adjust your monthly returns: If you have made an error in completing your return, you can go
back to that return, enter the correct figures, and send it to this Office with either payment or a request for a
refund or credit note. Please mark the return "Amended Return".

                                   Return to Top

Problems & technical advice: If you experience any difficulties with the operation of the spreadsheet,
phone 1300 305 353 for assistance.

General information:
For more detailed information on general insurance matters, please do not hesitate to contact this Office at
the addresses or contact numbers above.
GUIDANCE NOTES
Gross Premium: Is the amount charged for the policy without any deduction for any discount allowed,
commission to an agent or other person for arranging the policy or any Goods and Services Tax (GST)
payable in relation to the supply of the policy. It does not include any stamp duty payable in respect of the
policy or re-insurance premiums.

Due Date: The return is to be furnished and the duty paid within 21 days after the close of the period it
relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.

Records: A copy of the return should be retained as part of your records for audit purposes for a period of
not less than five (5) years.

Electronic Funds Transfer (EFT): This convenient method of payment is quick and easy to use. Approval
is not required to pay by EFT, simply follow these steps:
  1. Complete your return and calculate the duty payable.
  2. Using your PIN (see below), transmit the payment to:
          Bank:            National Australia Bank
          Account Name: NTT Territory Revenue Office
          BSB:            085 933
          Account No:       187 960 174
  3. Fax your return to (08) 8999 5577 noting that duty has been paid by EFT.

About your payment identification number (PIN): All registered life insurers are allocated a unique
EFT 'PIN'. It consists of their six digit registration number, the tax code (INS) and the month and
the year of the relevant return period. For example, the PIN for registered life insurer 123456 for
February 2012 is 123456INS0212. The last four digits change for each return period.

Important: To avoid delays and inconvenience, your complete PIN must be transmitted with
your payment.
                                                   Territory Revenue Office                                    For help please phone
                                                                                                               1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 07/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801.Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                              For help please phone
                                                   Territory Revenue Office
                                                                                                              1300 305 353 for
                                                       Stamp Duty Act                                         assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 08/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                               "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                              For help please phone
                                                   Territory Revenue Office                                   1300 305 353 for
                                                       Stamp Duty Act                                         assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 09/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                               "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801.Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT


              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                               For help please phone
                                                   Territory Revenue Office                                    1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 10/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition interest of penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revebue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                   Territory Revenue Office                                   For help please phone
                                                       Stamp Duty Act                                         1300 305 353 for
                                                   General Insurance Return                                   assistance.



                                                                             Registration Number:                    0
                                                                       Return Period (eg 11/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                               "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT


              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                               For help please phone
                                                   Territory Revenue Office
                                                                                                               1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 12/2007):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                               For help please phone
                                                   Territory Revenue Office                                    1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 01/2008):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                               For help please phone
                                                   Territory Revenue Office                                    1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 02/2008):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirementsmay result in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                   Territory Revenue Office                                    For help please phone
                                                       Stamp Duty Act                                          1300 305 353 for
                                                   General Insurance Return                                    assistance.



                                                                             Registration Number:                    0
                                                                       Return Period (eg 03/2008):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                              For help please phone
                                                   Territory Revenue Office                                   1300 305 353 for
                                                       Stamp Duty Act                                         assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 04/2008):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may resukt in the imposition of interest and penalty tax.

3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                               "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                                               For help please phone
                                                   Territory Revenue Office
                                                                                                               1300 305 353 for
                                                       Stamp Duty Act                                          assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 05/2008):


                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                                "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                   Territory Revenue Office                                   For help please phone
                                                                                                              1300 305 353 for
                                                       Stamp Duty Act                                         assistance.
                                                   General Insurance Return


                                                                             Registration Number:                    0
                                                                       Return Period (eg 06/2008):

                Legal Entity:                                                        0

    PART A - DETAILS OF INSURANCE PREMIUMS
  Gross premiums received on every policy or renewal of a policy                          A

  Duty Payable at 10%                                                                                Enter your registration number

  Less duty on premiums refunded in respect of surrendered or cancelled
  policies                                                                                B
  Net Duty Payable (rounded down to nearest five cents)                                   C          Enter your registration number

    NOTES FOR GUIDANCE
1 GROSS PREMIUMS - Is the amount charged for the policy without any deduction for any discount allowed,
  commission to an agent or other person for arranging the policy or any GST payable in relation to the supply of the
  policy. It does not include any stamp duty payable in respect of the policy or re-insurance premiums.
2 DUE DATE - The return is to be furnished and the duty paid within 21 days after the close of the return period
  it relates to. Failure to satisfy these requirements may result in the imposition of interest and penalty tax.
3 FURTHER INFORMATION - Refer to the web site www.revenue.nt.gov.au to obtain further return forms, general circulars and
  other information or contact this Office on 1300 305 353.
  PART A - To be retained as part of your records for audit purposes for a period of not less than 5 years.
  PART B - To be completed, detached and returned with payment.
"                                     "                                                                                               "
    PART B - GENERAL INSURANCE RETURN REMITTANCE ADVICE
  You may use this worksheet as a remittance advice. Print the return, detach the remittance advice and mail with your cheque
  (made payable to "Receiver of Territory Monies") to Territory Revenue Office GPO Box 154 Darwin NT 0801. Payments can
  also be made by EFT or personnally at Level 4, 38 Cavenagh St Darwin NT.

              Registration No:                                           GROSS PREMIUMS - A:                      $0.00
                     0
              Return Period:                                      REFUNDED PREMIUMS - B:                          $0.00

                Legal Entity                                            NET DUTY PAYABLE - C:Enter        your registration number
                     0
    DECLARATION - BY AUTHORISED PERSON: (complete and sign after printing)

    I certify that the details provided in this statement are true and correct in every particular


  Signature                                                                                    Date: ____/____/_______



  If signing on behalf of a corporation, provide your position title


  Warning: It is an offence under the Taxation Administration Act to provide information that you know is misleading in a
  material particular (maximum penalty 400 penalty units – current penalty unit values are available from the TRO website
  www.revenue.nt.gov.au).


  PRIVACY STATEMENT
  The information requested in this form is required by law to determine your stamp duty liability. The information may be
  communicated to persons authorised under the Act. You may review or correct any personal information provided by
  contacting the Territory Revenue Office.


                                                 TERRITORY REVENUE OFFICE
                 GPO Box 154, Darwin NT 0801 ph: 1300 305 353 fax (08) 8999 5577 www.revenue.nt.gov.au
                                                                                Territory Revenue Office
                                                               General Insurance Return Worksheet - Stamp Duty Act                                                                             FOR SINGLE CLIENT'S INFORMATION PURPOSES ONLY



 DETERMINATION OF
                                 July                   Aug                    Sept                    Oct                   Nov                     Dec                    Jan                     Feb                      Mar                   April                  May                      June              TOTAL for the f/y
   DUTY PAYABLE
MONTHLY PREMIUMS
   DUTIABLE PREMIUMS
                                          0.00                   0.00                   0.00                   0.00                   0.00                   0.00                   0.00                      0.00                   0.00                   0.00                   0.00                      0.00                    0.00
              TOTAL $

                                     Enter your             Enter your             Enter your             Enter your             Enter your             Enter your             Enter your   Enter your registration             Enter your             Enter your             Enter your   Enter your registration
       DUTY PAYABLE $                                                                                                                                                                                                                                                                                                                0.00
                           registration number    registration number    registration number    registration number    registration number    registration number    registration number                  number      registration number    registration number    registration number                  number


  LESS - DUTY PAID ON
           REFUNDED,
                                          0.00                   0.00                   0.00                   0.00                   0.00                   0.00                   0.00                      0.00                   0.00                   0.00                   0.00                      0.00                    0.00
    SURRENDERED OR
  CANCELLED POLICIES
   TOTAL of reductions $                  0.00                   0.00                   0.00                   0.00                   0.00                   0.00                   0.00                      0.00                   0.00                   0.00                   0.00                      0.00                    0.00

Net Duty Payable                         Error                  Error                  Error                  Error                  Error                  Error                  Error                     Error                  Error                  Error                  Error                     Error                    0.00

				
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