1609 pr form-2026

The document is a report form from the Commonwealth of Pennsylvania Insurance Department, specifically for transactions with unlicensed insurers under the Surplus Lines of the Insurance Company Law. It requires producers to declare their efforts in obtaining insurance coverage from licensed insurers and to provide details about the insured, coverage type, and effective dates. The producer must also inform the insured about the unlicensed status of the insurer and compliance with relevant insurance laws.

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Click ‘Get Form’ to open the 1609 pr form in the editor.
Begin by entering your Customer ID, Policy Number, and Binder Number at the top of the form. These identifiers are crucial for tracking your transactions.
In the 'Insured Name' field, input the name of the insured party. Follow this by providing the 'Location of Risk', including city and zip code.
Fill in the 'Total Insured Value' and provide a brief 'Description of Insured’s Operation'. This helps clarify what is being insured.
Select the 'Type of Coverage' and specify the 'Amount of Insurance'. Ensure you also indicate the effective dates for coverage.
Complete any additional required fields, ensuring all information is accurate to avoid delays in processing.
Finally, review your entries for accuracy before signing as a producer. Include your license number and date to validate your submission.

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What is an example of a surplus line?

Appendix A StateStatutory Citation to Insurance CodeTax Rate Applied California 1775.5 1775.1(a) 3% (+ stamping fee of 0.18%, effective Jan. 1, 2023) (monthly or annual based on prior year tax liability). Colorado 10-5-111 3% Connecticut 38(a)-743 4% (quarterly) Delaware 1925 3%101 more rows

What is surplus line tax?

What is Surplus Lines Tax? Surplus lines tax is a type of tax that is imposed on insurance policies that are not covered by the states admitted insurance market. This means that the insurance policy is not regulated by the states insurance department and is instead placed with a non-admitted insurance company.

What is the surplus line tax in PA?

Overview. This tax is 3 percent of gross premiums and must be collected at the time of the delivery of the policy. Licensed surplus lines agents are required to file RCT-123, Gross Premiums Tax Surplus Lines Agents Report, and remit the taxes due to the Department of Revenue by Jan. 31 of the following year.

What is the tax rate for surplus lines in PA?

This tax is 3 percent of gross premiums and must be collected at the time of the delivery of the policy. Licensed surplus lines agents are required to file RCT-123, Gross Premiums Tax Surplus Lines Agents Report, and remit the taxes due to the Department of Revenue by Jan. 31 of the following year.