Pennsylvania Gross Premiums Tax Report

Gross Premiums Tax Report
Gross Premiums Tax - Surplus Lines Agents (RCT-123)
IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING
FILL IN FORM USING ALL CAPS. DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1230022105

rct-123

OFFICIAL USE ONLY
Date Received (Official Use Only)

Page 1 of 3

08-22 (FI)

groSS PreMIUMS taX
SUrPLUS LINeS ageNtS

c

Tax Year Begin:
START

Revenue ID

Federal ID (FEIN)

Parent Corporation (FEIN)

➜

Tax Year End:

12/31/20_ _
Due Date: January 31
Please select correct letter in drop down

Taxpayer Name

Check to Indicate a Change of Address
Amended Report (Include REV-1175.)
First Report

First Line of Address
Second Line of Address

Final Report (See Instructions.)
City

State

ZIP
Out of Existence Date:

Phone
Email

USe whoLe DoLLarS oNLy

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Total Tax (From Page 2, Line 2)
Total Estimated Payments
Total Payments Carried Forward From Prior Year Return
Total “Restricted” Tax Credits
Total Credit: (Line 2 plus Line 3 plus Line 4)
Tax Due: (If Line 1 is more than Line 5, enter the difference here.)
Remittance
Overpayment: (If Line 5 is more than Line 1, enter the difference here.)
Refund: (Amount of Line 8 to be refunded after offsetting all unpaid liabilities)
Transfer: (Amount of Line 8 to be credited to the next tax year after offsetting
all unpaid liabilities)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

1230022105

corporate officer Information:

Officer Last Name

Social Security
Number of Officer

Officer First Name
Title of Officer

Phone
Email

I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete report. If this report is an amended report, the taxpayer hereby consents to the extension of the assessment
period for this tax year to one year from the date of filing of this amended report or three years from the filing of the original report, whichever period last expires,
and agrees to retain all required records pertaining to that tax and tax period until the end of the extended assessment period, regardless of any statutory
provision providing for a shorter period of retention. For purposes of this extension, an original report filed before the due date is deemed filed on the due date.
I am authorized to execute this consent to the extension of the assessment period.

Signature of officer

Date
Signature of Officer – Please sign after printing

Reset Entire Form

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FILL IN FORM USING ALL CAPS.DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.

1230022205

rct-123

08-22 (FI)

Revenue ID

Page 2 of 3

caLcULatIoN of taX

c

PSLA 4-Digit Customer ID Number

USe whoLe DoLLarS oNLy

1.
2.

1.
2.

Total of Taxable Premiums (From Schedule A, below)
Total Tax (Line 1 times tax rate - See Instructions.) Carry to Page 1, Line 1.

Schedule a
taxable Premiums
TOTAL PREmIUmS REPORTED
ON mONThLY 1620 REPORT

Revised

multiple

January
February
march
April
may
June
July
August
September
October
November
December

total of taxable Premiums
MUSt carry totaL taXaBLe PreMIUMS to LINe 1 aBoVe.

taxpayers are required to provide copies of all monthly 1620 reports filed with the
Pennsylvania Surplus Lines association during this tax year.
If filing for Several Branch offices, complete Schedule B - Page 3.

Preparer’s Information:

1230022205

Firm Name
Firm FEIN
Address
City
State
ZIP

Individual Preparer Name
Phone
Email
Social Security Number
or PTIN

I affirm under penalties prescribed by law, this report, including any accompanying schedules and statements, has been prepared by me and to the best of
my knowledge and belief is a true, correct and complete report.

Signature of Preparer

Date
Signature of Preparer – Please sign after printing

Reset Entire Form

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rct-123

08-22 (FI)

Page 3 of 3

Revenue ID

1230022305
groSS PreMIUM taX rePort
BraNch offIce ScheDULe
ScheDULe B

1230022305

EIN:

Taxpayer Name

customer
ID #

address

total
gross
Premiums

Less total
return
Premiums

Less tax
exempt
Premiums

gross
Premiums
taxable

tax amount
at 3% of
gross
Premiums

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grand totals:

1230022305

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Instructions for RCT-123

Gross Premiums Tax - Surplus Lines Agents

RCT-123 (SU) IN 10-23

GENERAL INFORMATION
● The RCT-123 can now be filed electronically at
mypath.pa.gov.
REMINDER
● All payments of $1,000 or more must be made electronically or by certified or cashier’s check remitted in
person or by express mail courier.
● Use only whole dollars when preparing tax reports.
● Taxpayers may request a 60 day extension to file this
report electronically via myPATH or by filing the
REV-426.
NOTE: The automatic PA extension provided by
Act 52 of 2013 to those with valid federal extensions DOES NOT apply to this tax.
● The penalty imposed for failure to file timely reports is a
minimum of $500, regardless of the determined tax liability, plus an additional 1 percent of any determined tax
liability over $25,000.
● Use ONLY the most current, non-year-specific tax form
and instructions for filing ALL tax years. If an amended
report must be filed, taxpayers must use the most
current, non-year-specific tax form, completing all
sections of the form. REV-1175, Schedule AR (explanation for amending), must be included when filing
an amended report.
● One RCT-123 must be filed for each agency and report
for all branch offices and/or all individual agents filing
under the same FEIN.
● The tax liability on RCT-123 cannot be less than zero;
instead the taxpayer must file a petition for refund.
ANNUAL REPORT CHECKLIST
Make sure you include the following to file your annual report
properly and completely:
● Negative amounts must be written using a minus sign
preceding the number. Do not use parentheses.
● Complete RCT-123, Gross Premiums Tax Report for
Surplus Lines Agents
● Attach copies of the monthly 1620 reports as filed with
the Pennsylvania Surplus Lines Association on behalf
of the Pennsylvania Insurance Department.
● Corporate officer’s signature on Page 1 and preparer’s
signature and PTIN on Page 2, if applicable
● A signed copy of all three pages of the RCT-123 tax
report and the monthly 1620 reports must be filed electronically with the Pennsylvania Surplus Lines Association in the Electronic Filing System (EFS).

IMPOSITION, BASE AND RATE
The gross premiums 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 with eligible surplus lines
insurers and other non-admitted insurers through duly
licensed surplus lines producers. The tax is in addition to
the premium charged by the insurer. The tax is levied on the
insured that procured the insurance with eligible surplus
lines insurers or other non-admitted insurers and is collected
and remitted by the surplus lines producer. The tax on any
unearned portion of the premium must be returned to the
insured by the agency or agent. Political subdivisions are
exempt from this tax.
LOCATION OF RISK
If the policy involves risk located in multiple states including
Pennsylvania, then the taxable premiums shall be levied as
follows:
If Pennsylvania is the home state of the insured, the gross
premiums 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.
REVENUE ID, FEDERAL EMPLOYER IDENTIFICATION
NUMBER (FEIN), PARENT CORPORATION FEIN, NAME
AND ADDRESS
The Revenue ID number, FEIN, name, and complete mailing
address must be provided. If the taxpayer is a subsidiary
of a corporation, the parent corporation’s FEIN must be
provided. Also provide the telephone number and email
address of the taxpayer.
TAX YEAR
Enter month, day, and year (MMDDYYYY) for the tax year
beginning and year (YY) for the tax year end.
REPORT DUE DATE
This report is due on Jan. 31 for the preceding year ended
Dec. 31. If Jan. 31 falls on a Saturday, Sunday, or holiday,
the report is due the next business day. The penalty imposed
for failure to file timely reports is now a minimum of $500,
regardless of the determined tax liability, plus an additional
1 percent of any determined tax liability over $25,000.
ADDRESS CHANGE
Enter “Y” in the block on Page 1 if the address of the corporation has changed from prior tax periods. The current
mailing address should be reflected on the report.
AMENDED REPORT
Enter “Y” in the block 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.

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The taxpayer has three (3) years after the due date of the
original report to file an amended report. If the original report
was properly extended, then the taxpayer has three (3)
years after the extended due date to file an amended 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.
FINAL REPORT
● Enter “Y” in the block on Page 1 if this report will be the
final report filed with the department. Indicate the effective date of the event as MMDDYYYY.
● Include information from the Pennsylvania Insurance
Department verifying the taxpayer’s insurance license
expired, was cancelled or not renewed.
● Include a copy of the regulatory authority’s approval of
the merger, dissolution, plan of reorganization, and/or
articles of merger.
● Provide the Revenue ID and FEIN of the surviving entity,
if applicable.

with an extension request should not submit the extension
coupon. Do not use the extension coupon to remit other
unpaid liabilities within the account.
PAYMENT AND MAILING INFORMATION
All payments of $1,000 or more must be made electronically
or by certified or cashier’s check mailed to:
PA DEPARTMENT OF REVENUE
PO BOX 280404
HARRISBURG PA 17128-0404
Tax returns and certified or cashier’s check may be remitted
in person or by express mail courier. Mail payments and
returns to the following address:
PA DEPARTMENT OF REVENUE
1854 BROOKWOOD ST
HARRISBURG PA 17104
Payments under $1,000 may be remitted by mail, made
payable to the PA Department of Revenue. Mail payments,
extension requests and returns to the following address:
PA DEPARTMENT OF REVENUE
PO BOX 280427
HARRISBURG PA 17128-0427
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 mypath.pa.gov.
CURRENT PERIOD OVERPAYMENT
If an overpayment exists on Page 1 of the RCT-123, the taxpayer must instruct the department to refund or transfer
overpayment as indicated below.

CORPORATE OFFICER INFORMATION
A corporate officer 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 of the corporate
officer.

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 within
the account.

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,
and PTIN/SSN 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,
and PTIN/SSN of the individual preparing the report.

TRANSFER
Identify the amount to transfer from the current tax period
overpayment to the next tax period. Prior to any transfer, the
department will offset current period liabilities and other
unpaid liabilities within the account.

EXTENSION REQUEST DUE DATE
To request a due date extension of up to 60 days to file the
annual report, you must file an extension request by the original report due date. You can request an extension on
mypath.pa.gov or by sending the REV-426. However, an
extension of time to file does not extend the deadline for payment of tax, and an extension request must be accompanied
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
2

RCT-123

NOTE: If no option is selected, the department will
automatically transfer any overpayment to the next tax
year after offsetting current period liabilities and other unpaid
liabilities within the account.
REQUESTS FOR REFUND OR TRANSFER OF
AVAILABLE CREDIT
Requests for refund or transfer of available credit from prior
periods can be requested on company letterhead, signed
by an authorized representative, and emailed to
[email protected].
Please do not duplicate requests for refund and/or transfer
by submitting both RCT-123 and written correspondence.
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CONTACT INFORMATION
● For additional information regarding electronic payments
visit the departments Online Customer Service Center
at revenue.pa.gov.
● Questions regarding payments or refunds, email
[email protected].
● General business tax questions, visit the department's
Online Customer Service Center at revenue.pa.gov.
● Business taxpayers and tax practitioners have the ability
to receive and view department issued electronic
statement of accounts and correspondence
electronically by visiting mypath.pa.gov.
● If you have questions regarding filing a copy of this
return electronically with the Pennsylvania Surplus Lines
Association, call the Pennsylvania Surplus Lines
Association at 610-594-1340 or visit their website at
www.pasla.org.

LINE INSTRUCTIONS
RCT-123 should be completed in the following order:
(Page instructions start with Page 3 below.)
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 B, Branch Offices.
STEP 4
Complete Page 2, Schedule A, Taxable Premiums.
STEP 5
Complete the Calculation of Tax at the top of Page 2.

SCHEDULE B
BRANCH OFFICE
Complete Schedule B if the producer has multiple branch
offices filing under the same FEIN.
NOTE: You are required to file a copy of each monthly
1620 report for each branch office that is reported on
this schedule.
CUSTOMER NUMBER
Enter the number assigned by the Pennsylvania Surplus
Lines Association for each branch.
ADDRESS
Enter the address of each branch office.
TOTAL GROSS PREMIUMS
Enter the total yearly gross premiums for each branch. This
total MUST include returned and/or exempt premiums; these
adjustments are made in the next two columns.
LESS TOTAL RETURNED PREMIUMS
Enter the total returned premiums for each branch.
LESS TAX EXEMPT PREMIUMS
Enter the total exempt premiums for each branch.
GROSS PREMIUMS TAXABLE
Enter the difference of total gross premiums less returned
premiums less tax exempt premiums for each branch. Taxable gross premiums cannot be less than zero.
GRAND TOTALS
Enter the sum of all gross premiums taxable. This figure must
reconcile to the total as reported on Page 2, Schedule A.

STEP 6
Complete Page 1, Lines 1 through 10.

TAX AMOUNT

STEP 7
Complete the corporate officer information section, sign, and
date at the bottom of Page 1.

GRAND TOTALS

STEP 8
Complete the preparer information section, sign, and date
at the bottom of Page 2, if applicable.
STEP 9
Mail the completed report and any supporting schedules to
the PA Department of Revenue.
STEP 10
File a signed copy of all three pages of the RCT-123 tax
report and the monthly 1620 reports electronically with the
PA Surplus Lines Association in the Electronic Filing System
(EFS).

Multiply the gross premiums taxable column by 0.03.
Enter the sum of all tax amounts. This figure must reconcile
to the total as reported on Page 2, Line 2.
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
premiums 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.

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CALCULATION OF TAXABLE GROSS PREMIUMS

SCHEDULE A
TAXABLE PREMIUMS
MONTHLY PREMIUMS
Enter the taxable premiums as reported on the monthly 1620
reports for each of the 12 months. If there are multiple
branches, this will be the sum of all monthly 1620 reports for
the respective month.
REVISED
Check the appropriate box if a revised monthly 1620
report is included for any month.
NOTE: If the revised monthly 1620 report was submitted to the PSLA prior to filing the original RCT-123,
provide the latest documents and figures. If the original RCT123 has been submitted prior to the revised monthly 1620
report, an amended RCT-123 must be filed indicating what
month(s) have been revised. The revised monthly 1620
report must be provided.

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RCT-123

MULTIPLE
Check the appropriate box if the producer has multiple
branches in which multiple monthly 1620 reports are being
filed for any month.
TOTAL OF TAXABLE PREMIUMS
Enter the sum of the taxable premiums for January through
December. This must reconcile to the total of the monthly
1620s included with this report.

LINE 1
TAXABLE PREMIUMS
Enter the total of taxable premiums from Schedule A.

LINE 2
TOTAL TAX
Multiply Line 1 by 0.03. Carry the tax to RCT-123 Page, 1
Line 1.
Tax liability cannot be less than zero.

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