Massachusetts Department of Revenue
                                                              Form 63-20P
                 Premium Excise Return for Life Insurance Companies                                                                                                                                                2020

For calendar year 2020.
Name of company                                                                                            Federal Identification number                             State of incorporation

Mailing address

City/Town                                                                                                         State              Zip                                                 Phone number

Name of treasurer

Fill in if:
  Amended return (see “Amended Return” in instructions)               Federal amendment                              Federal audit
  Enclosing Schedule TDS      Final return                    Initial return      Name change                        Address change
Fill in if federal government has changed your taxable income for any prior year which has not yet been reported to Massachusetts

Excise calculation
Domestic life insurers. Enclose a copy of Schedule T of NAIC annual statement.
11  Taxable life premiums (from Part 1, line 10). . . . . . . . . . . . . . . . . . . . . . . . . . .                                       × .0200 =                                                1
12  Net value of policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        × .0025 =                                                2
13  Applicable measure (from line 1 or line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14  Taxable accident and health premiums (from Part 1, line 11). . . . . . . . . . . . . .                                                  × .0200 =                                                4
15  Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                      5
16  Excise due before credits. Add lines 3 through 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                6

Foreign life insurers. Enclose a copy of Schedule T of NAIC annual statement.
17  Taxable life premiums (from Part 2, line 7). . . . . . . . . . . . . . . . . . . . . . . . . . . .                                      × .0200 =                                                7
18  Retaliatory computation (from Part 3, col. a). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19  Applicable measure (enter the larger of lines 7 or 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                 9
10  Taxable accident and health premiums (from Part 2, line 12). . . . . . . . . . . . .                                                    × .0200 =                                                10
11  Retaliatory computation (from Part 3, col. b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               11
12  Applicable measure (enter the larger of lines 10 or 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                     12
13  Credit recapture (enclose Credit Recapture Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                        13
14  Excise due before credits. Add lines 9, 12 and 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                   14

Declaration
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return and enclosures are true, correct and complete.
Signature of appropriate corporate officer (see instructions) Date                                                   Social Security number                                                            Phone number

Signature of paid preparer                                    Date                                                   Employer Identification number                                                    Address

If you are signing as an authorized delegate of the appropriate corporate officer, fill in oval                      and enclose Massachusetts Form M-2848, Power of
  Attorney. The Privacy Act Notice is available upon request. Mail to Massachusetts Department of Revenue, PO Box 7052, Boston, MA 02204.

                                                                                                            2020 FORM 63-20P, PAGE 2

Name of company                                                                                            Federal Identification number                             State of incorporation

Excise calculation (cont’d.)
Credits. Do not claim any credit here if claimed on Form 63-23P.
15  Enter 1.5% of company’s capital contribution in excess of the full proportionate share in the Massachusetts life 
  insurance company community investment initiative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          15
16  Enter 1.5% of proportionate share of cost of equity securities and outstanding principal balance of debt securities
  constituting of qualified investments of Massachusetts Capital Resource Company (enclose computation). . . . . . . . . .                                                            16
17  Enter 10% of Massachusetts Life and Health Insurance Guaranty Association assessment paid in the prior years 
  (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18  Other credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   18
19  Total credits. Add lines 15 through 18  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           19

Excise after credits
20  Excise due before voluntary contribution. Subtract line 19 from line 6 or line 14, whichever applies. Not less than 0. . . 20
21  Voluntary contribution for endangered wildlife conservation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          21
22  Total excise plus voluntary contribution. Add lines 20 and 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          22

Payments
23  2019 overpayment applied to 2020 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       23
24  2020 Massachusetts estimated tax payments (do not include amount from line 23). . . . . . . . . . . . . . . . . . . . . . . . . . . .                                             24
25  Payments made with extension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             25
26  Payment with original return. Use only if amending return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        26
27  Pass-through entity withholding. . . . . . . . . . . . . . . . . . . . .  Payer Identification number 3                                                                           27
28  Refundable credits (from Credit Manager Schedule). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        28
29  Total payments. Add lines 23 through 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                29

Refund or balance due
30  Amount overpaid. If line 29 is greater than line 22, subtract line 22 from line 29. Otherwise, go to line 33. . . . . . . . . . .                                                 30
31  Amount overpaid to be credited to 2021 estimated tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         31
32  Amount overpaid to be refunded. Subtract line 31 from line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                            32
33  Balance due. Subtract line 29 from line 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               33
34a M-2220 penalty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  34a
34b Other penalties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34b
34  Total penalty. Add lines 34a and 34b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35  Interest on unpaid balance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       35
36  Total payment due at time of filing. Add lines 33, 34 and 35. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         36

                                                                                                                                           2020 FORM 63-20P, PAGE 3

Name of company                                                                                            Federal Identification number                             State of incorporation
3                         3

Part 1. Domestic life premium excise calculation
                                                                                   — Life insurance —                        — Accident and health insurance — 
                                                                                                                                           b.                                                                                 d.
                                                                                                                            Jurisdictions where                                                  Jurisdictions where
                                                                                                  a.                             no insurance                             c.                             no insurance
                                                                                      Massachusetts                   excise paid                   Massachusetts                   excise paid
11  All new and renewal (direct) premiums
      for Massachusetts residents. . . . . . . . .31
12  Dividends applied to:
      a Purchase paid-up additions. . . . . .             3 2a
      b Shorten premium paying period. . .                3 2b
13  Total add lines 1 through 2b. . . . . . . . . . . 3

Deductions. Include only what has been returned as receipts on this return or on a previous return.
14  Returned premiums but not including 
      cash surrender values (enclose 
      schedule). . . . . . . . . . . . . . . . . . . . . . . .34
15  Premiums for company employees’
      group life and accident and health 
      plans if included in line 1*. . . . . . . . . . .35
16  Gross premiums for authorized pre-
      ferred provider arrangements. . . . . . . .36
17 Dividends:
      a Paid in cash. . . . . . . . . . . . . . . . . .   3 7a
      b Applied in reduction of renewal
      premiums. . . . . . . . . . . . . . . . . . . .     3 7b
      c Left to accumulate at interest. . . . .           3 7c
      d Applied to purchase paid-up 
      additions. . . . . . . . . . . . . . . . . . . . .  3 7d
      e Applied to shorten premium paying
      period. . . . . . . . . . . . . . . . . . . . . . . 3 7e
18  Total deductions. Add lines 4 through 
      7e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19  Amount taxable. Subtract line 8 from 
      line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10  Total life amount taxable. Add line 9, columns a and b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11  Total accident and health amount taxable. Add line 9, columns c and d. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
*Premiums under the company employees’ group plans for annuity consideration and retirement benefits shall not be deducted.

                                                                                                                          2020 FORM 63-20P, PAGE 4

Name of company                                                                                            Federal Identification number                             State of incorporation
3                         3

Part 2. Foreign life premium excise calculation
Life premiums
11  All new and renewal direct premiums for all policies of life insurance allocable to Massachusetts. . . . . . . . . . . . . . . .3. 1
12  Dividends applied to:
      a Purchase paid-up additions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           3 2a
      b Shorten premium paying period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              3 2b
13  Total gross direct premiums. Add lines 1, 2a and 2b. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3.3. 
14  Returned premiums but not including cash surrender values. Enclose itemized supporting schedule. . . . . . . . . . . . .3.                                                        4
15 Dividends:
      a Paid in cash. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5a
      b Applied in reduction of renewal premiums. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   3 5b
      c Left to accumulate at interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         3 5c
      d Applied to purchase paid-up additions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                3 5d
      e Applied to shorten premium paying period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 5e
16  Total deductions. Add lines 4 through 5e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3.6. 
17  Taxable premiums. Subtract line 6 from line 3. Enter result on page 1, line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3.7

Accident and health premiums
18  Total net direct premiums for insurance of property or interests in Massachusetts. . . . . . . . . . . . . . . . . . . . . . . . . . . .3.8. 
19  Dividend deduction. Premiums returned or credited to policyholders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. .9
10  Premium deduction. Gross premiums for authorized Preferred Provider arrangements. . . . . . . . . . . . . . . . . . . . . . . .                                                   3 10
11  Total deductions. Add lines 9 and 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               3 11
12  Taxable amount. Subtract line 11 from line 8. Enter result on page 1, line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                      3 12
13  Fill in if net direct premiums are reported in line 8 
14  Fill in if all dividends claimed as a deduction in line 9 have been included as taxable premiums in line 10 on this return or on a previous Massachusetts
      return

                                      2020 FORM 63-20P, PAGE 5

Name of company                                                                                            Federal Identification number                             State of incorporation
3                         3

Part 3. Computation of retaliatory tax
Use the space below to calculate your excise using the identical method and the same rate used by the state in which you are incorporated in taxing a
like Massachusetts insurance company, or its agents, if doing business to the same extent. If the computation in the state of your incorporation is in every
respect the same as your Massachusetts computation, a statement to that effect should be made.
a. Life computation

b. Accident and health computation