Instructions For Rct-123 Return printable pdf download

Instructions for RCT-123 Return

RCT-123-I (11-11) (I)

Imposition Base and Rate

Gross premium tax is imposed under the Act of May 17, 1921, P.L. 682, No. 284 at the rate of 3 percent on gross premiums of insurance

procured through eligible surplus lines agents and other non-admitted insurers. The tax is in addition to the premium charged by the insurer.

While the tax is levied on taxpayers who procure insurance through eligible surplus lines agents or other non-admitted insurers, it is

collected through surplus lines agents. The tax on any unearned portion of the premium must be returned to the insured.

Political subdivisions are exempt from this tax.

Branch Offices

Complete the Branch Office Schedule on Page 3. With questions, call the PA Surplus Lines Association at 1-888-209-3230 (only from within

PA) or 610-594-1340.

Amended Report

Check this box 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.

The department may adjust the tax originally reported based on information from the amended report. The department will not make a tax

adjustment three years beyond the receipt date of the original report unless the taxpayer consents to extending the assessment period.

When filing an amended report, record the amended tax liability on Page 1, Column A.

Last Report

If checking this box, include information from the PA Insurance Department verifying the taxpayer’s surplus lines license expired or was not

renewed.

Filing Guidelines

• File only ONE report for the calendar year listing all surplus lines activity for that year. Do not submit this report on a monthly basis.

• Money may be paid as collected. Indicate on each check stub the account name, account ID assigned by the Department of Revenue and

FEIN.

• When completing the top of Page 2, provide the information requested on the form and attach copies of all monthly 1620 reports filed

with the PA Surplus Lines Association during the year.

• Page 2, Line 2: Information required for each cancelled policy:

1. Name of original insured

2. Location of original property

3. Name of company originally issuing the policy

4. Policy number

5. Date of cancellation

6. Type of insurance

7. Amount of cancellation

• Page 2, Line 3: Information required for each exempt policy:

1. Name of insured

2. Government entity classification: If yes, continue with Numbers 3, 4 and 5.

3. Amount of exempt gross premiums

4. Location of property

5. Policy number

IMPORTANT: A reminder from the PA Department of Insurance

A signed copy of all three pages of the RCT-123 tax report and the 1620 monthly reports must be filed electronically with the PA Surplus

Lines Association in the Electronic Filing System (EFS). Questions regarding this requirement should be directed to the PA Surplus Lines

Association at 1-888-209-3230 (only from within PA) or 610-594-1340.

Instructions For Rct-123 Return