Instructions For Form Rct-122 - Gross Premiums Tax Report (Page 2 of 5) in pdf

General Information for RCT-122

RCT-122-I (1-15)

Page 2 of 5

Correspondence to Preparer

Enter “Y” in the block on Page 1 if all correspondence (notices and requests for additional information) is to be sent to the preparer’s address.

If “Y” is entered, the address recorded on Page 2 will be used.

Amended Report

Enter “Y” in the block on Page 1 if you are filing an amended report to add, delete or adjust information. Provide documentation to support

all changes being made. An amended report should only be filed if an original report was filed previously for the same period.

An amended report must be filed within three years of the filed date of the original report. The department may adjust the tax originally

reported based on information from the amended report. The taxpayer must consent to extend the assessment period. If the amended report

is timely filed and the taxpayer consented to extend the assessment period, the time period in which to assess tax will be the greater of

three years from the filed date of the original report or one year from the filed date of the amended report.

Regardless of the tax year being amended, taxpayers must use the most current non-year-specific tax form, completing all sections of the

report. This includes those sections originally filed and those sections being amended. All tax liabilities should be recorded on Page 1.

Taxpayers must check the Amended Report check box on Page 1 and include Schedule AR, REV-1175, with the report.

First Report

Enter “Y” in the block on Page 1 if this is the taxpayer’s first PA gross premiums tax filing.

Electronic Payment

Enter “Y” in the block on Page 1 if the taxpayer has made any electronic payments using e-TIDES.

Last Report

NOTE: If you wish to remain active, do not mark the report as last or final.

• Do not file a last report if you wish to remain active. Rather, file a zero report accompanied by a statement indicating no policy or

policies were purchased or renewed during this period.

• If this report will be the last report filed with the department, enter Y in the block on Page 1 and indicate the effective date of the

event as MM DD YYYY.

• Include a letter with the tax report verifying no policy or policies were placed or renewed and no other insurance policy was obtained

from a company not authorized or admitted by the Pennsylvania Insurance Department.

• Include a copy of the regulatory authority’s approval of the merger, dissolution, plan of reorganization and/or articles of merger, if

applicable.

• Provide the Revenue ID and FEIN of the surviving entity, if applicable.

Corporate Officer Information

A corporate officer/insured must sign and date the tax report. The signature must be original; photocopies or faxes will not be accepted.

Print the first and last name, title, Social Security number, telephone number and email address of the corporate officer/insured.

Preparer’s Information

Paid preparers must sign and date the tax report. If the preparer works for a firm, provide the name, FEIN and address of the firm along

with the name, telephone number, email address and SSN/PTIN of the individual preparing the report. If the preparer is an individual

without any association to a firm, provide the name, address, telephone number, email address and SSN/PTIN of the individual prepar-

ing the report.

Extension Request Due Date

To request a due date extension of up to 60 days to file the report, you must file an extension request (REV-426) by the original report due

date. However, an extension of time to file does not extend the deadline for payment of tax, and an extension request must be accompa-

nied by payment of taxes owed for the taxable year for which the extension is requested. Mail the extension coupon separately from all

other forms. A taxpayer using an electronic method to make a payment with an extension request should not submit the extension coupon.

Do not use the extension coupon to remit other unpaid liabilities or commonwealth obligations within the account.

Payment and Mailing Information

Remittance should include tax plus interest and penalty, if applicable. Penalty and interest calculators can be found at

All payments of $1,000 or more must be made electronically. Failure to make a payment by an approved method

will result in the imposition of a 3 percent penalty of the tax due, up to $500. For more information on electronic filing options, visit

Payments under $1,000 may be remitted by mail, made payable to the PA Department of Revenue.Mail pay-

ments, extension requests and Tax Report, RCT-122, to the following address:

PA DEPARTMENT OF REVENUE

PO BOX 280407

HARRISBURG, PA 17128-0407

Current Period Overpayment

If an overpayment exists on Page 1 of the RCT-122, the taxpayer must instruct the department to refund or transfer overpayment as indi-

cated below.

Refund: Identify the amount to refund from the current tax period overpayment. Prior to any refund, the department will offset current

period liabilities and other unpaid liabilities or commonwealth obligations within the account.

Transfer: Identify the amount to transfer from the current tax period overpayment to the next tax period for estimated tax purposes. Prior

to any transfer, the department will offset current period liabilities and other unpaid liabilities or commonwealth obligations within the

account.

Instructions For Form Rct-122 - Gross Premiums Tax Report Page 2

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