Member Companies


Form MB0116 Assessable Premium Calculation For Michigan Basic Property - Due 03/01/24

ALL Property & Casualty Insurers must complete this form and submit it to the Michigan Basic Property Insurance Association on or
before March 1. Groups must submit a separate form for each company. The information submitted on this form is a statement of each company's Assessable Premiums as defined in Section 2901 (d) of the Michigan
Insurance Code.

Companies will be assessed based on the amounts reported. Please read the instructions and notes carefully.
Complete the entire form by filling in all fields.

Company Address
Line of Business Column 1Direct Michigan Premiums written(must agree with page 19, column 1 of annual statement) Column 2Dividends Paid or Credited(must agree with page 19, column 3 of annual statement. see notes below) Column 3(see notes below) Column 4(subtract column 2 and column 3 from column 1)



Allied Lines


Commercial Multiple Peril (Non Liability)


Inland Marine


Burglary and Theft


SUB TOTAL Add Column 4 Lines 1-5 ...............


Homeowners Multiple Peril


GRAND TOTAL Add column 4 Lines 6 and 7 ...............


Column 2 Only list dividends on premiums included in Column 1.

Column 3 Only list deductions to premiums included in Column 1. The deductions only include premiums on policies covering Michigan farm property and policies covering solely aircraft, watercraft and motor vehicles.

Column 4 Line 6 is the Basic Property Insurance assessable premium.

Column 4 Line 7 is the Home Property Insurance assessable premium.

Column 4 Line 8 is the Aggregate Property assessable premium.


Certification: I have examined this completed form and the information contained in it is complete and correct.