Instructions For Form Rct-122 - Gross Premiums Tax Report (Page 4 of 5) in pdf

RCT-122 – Line-by-Line Instruction

RCT-122-I (1-15)

Page 4 of 5

RCT-122 should be completed in the following order:

Step 1 - Complete the taxpayer information section and any applicable questions at the top of Page 1.

Step 2 - Enter the Revenue ID and other taxpayer information in the designated fields at the top of each page.

Step 3 - Complete Page 3, Schedule A and/or Schedule B.

Step 4 - Complete Page 2, Calculation of Tax.

Step 5 - Complete Page 1, Tax Liability, Payment and Overpayment sections.

Step 6 - Complete the corporate officer information section, sign and date at the bottom of Page 1.

Step 7 - Complete the preparer information section, sign and date at the bottom of Page 2, if applicable.

Step 8 - Mail the completed report and any supporting schedules to the PA Department of Revenue.

Step 9 - Send a signed copy of the RCT-122 to the Pennsylvania Surplus Lines Association on behalf of the Pennsylvania Insurance

Department, to 180 Sheree Blvd., Ste. 3100, Exton, PA 19341.

Page 3 - Schedule A and/or Schedule B

Complete Schedule A for life insurance and annuities and Schedule B for all other types of insurance.

Name of Insurance Company - Enter the name of the unauthorized foreign or alien insurance company used to procure the policy.

Location of Risk - Enter the location(s) the risk will cover.

Note: If the policy involves risk located in multiple states including Pennsylvania, the taxable premium shall be levied as follows:

If Pennsylvania is the home state of the insured, the gross premium shall be taxable to Pennsylvania. For more information see 40 P.S. §

991.1602, 40 P.S. § 991.1621 and 40 P.S. § 991.1622.

Policy Number - Enter the policy number.

Beginning Date of Policy and Term - Enter the beginning date and term of the policy. The beginning date of all policies must be the same

as the file month indicated on Page 1 of RCT-122.

Type of Insurance - Enter the type of insurance being procured, life or annuity, in Schedule A only, and all others in Schedule B.

Amount of Insurance - Enter the amount of the insurance policy.

Gross Premiums - Enter the amount of gross premiums on the policy.

Total - Enter the total amount of insurance and gross premiums for each schedule.

Premiums returned on cancelled policies should not be included in the total. See instructions below for Page 2, Lines 2 and 6; attach sepa-

rate schedules.

Page 2 - Calculation of Tax

Life Insurance and Annuities

Line 1 - Total Gross Premiums on Life Insurance and Annuities (Schedule A)

Enter the total gross premiums on life insurance and annuities reported on Page 3, Schedule A.

Line 2 - Total of Net Premiums Returned on Cancelled Policies of Life Insurance and Annuities

Enter the total net premiums returned on cancelled policies of life insurance and annuities. A schedule identifying the name of the insur-

ance company, location of risk, policy number, beginning date of policy, date of cancellation, type of insurance and amount of cancel-

lation for each cancelled policy of life insurance and annuities must be provided. Adjustment for cancelled policies cannot reduce tax-

able gross premiums to less than zero.

Line 3 - Taxable Gross Premiums on Life Insurance and Annuities

Subtract Line 2 from Line 1.

Line 4 - Tax on Taxable Gross Premiums on Life Insurance and Annuities

Multiply Line 3 by 0.02.

All Other Types of Insurance (Other Than Life Insurance and Annuities)

Line 5 - Total Gross Premiums on All Other Types of Insurance (Schedule B)

Enter the total gross premiums on all other types of insurance reported on Page 3, Schedule B.

Line 6 - Total of Net Premiums Returned on Cancelled Policies of All Other Types of Insurance

Enter the total net premiums returned on cancelled policies of all other types of insurance. A schedule identifying the name of the insur-

ance company, location of risk, policy number, beginning date of policy, date of cancellation, type of insurance and amount of cancel-

lation for each cancelled policy of all other types of insurance must be provided. Adjustment for cancelled policies cannot reduce tax-

able gross premiums to less than zero.

Line 7 - Taxable Gross Premiums on All Other Types of Insurance

Subtract Line 6 from Line 5.

Instructions For Form Rct-122 - Gross Premiums Tax Report Page 4

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