Surplus Lines Associates, LLC
11585 Jones Bridge Road, Ste 420-137
Alpharetta, GA 30022
Ph: 800-411-2682
Surplus Lines Affidavit and Tax Filing Procedures
This document is designed to provide an overview of the Surplus Lines filing procedures by
state. We will attempt to identify;
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Specific forms or data to be filed and the required supporting documentation
Documents or data required to complete the policy filing for each state
Timeframes for submitting the documents to Surplus Lines Associates, LLC
Filing schedules
Deliverables
Assumptions
Pennsylvania
Overview
Pennsylvania has an electronic filing system (EFS) administered by the Pennsylvania Surplus
Lines Association (PASLA). All filings are made through the EFS as a data entry function with a
document upload function for supporting documents or reports. The Surplus Lines Tax is 3%
and there is a $25 non-refundable filing fee per transaction. There are additional charges for
late filings. Stamping Fees are billed monthly and are due by the 25 th of the month. Billing is via
email generated by the PASLA around the 7th of the month based on transactions entered
during the month.
Filed Documents
There are three documents / reports that are required to be filed with the PASLA.
1. 1609-SLL due within 45 days of the effective date of the placement. The filing requires
an image of the completed, signed and dated writing producer affidavit 1609-PR
2. 1620 Monthly Report due within 30 days following the end of each month.
3. Annual RTC-123 Tax Form due Jan 31st. Filed with both the PA Dept. of Revenue and the
PASLA.
1609-SLL Affidavit Data Requirements
The following data is required to complete the 1609-SLL (Affidavit) filing. We believe all of the
data can be obtained from the policy common Dec page and line of business Dec pages, with
the exception of the filing type, PA Premium on multi-state risks and tax exemption. This will
need to be confirmed.
Policy Number or Binder Number
Note: Binder filings will required a policy number be filed once obtained
Reference Number – Optional for use by the Agency
Scanned image of the 1609-PR Producing Agent Affidavit in .pdf format
Filing Type (Continuous, ECP, Export or Other)
1609-PR – Most common. Used when no other filing types apply
1609-B – Continuous Placement
The same coverage has been placed continuously with an eligible surplus lines carrier
for a period of at least three consecutive years immediately preceding the current
placement. This form recognizes that this is, in fact, a Surplus Lines placement,
precludes the diligent search requirement and no longer requires a Producer
declaration / affidavit
1610-A – Exempt Commercial Purchaser
1610-E – Type of Coverage or a Description of Insured’s Operation found on the Export List
Insured Name
Location of Risk
Type of Coverage – Example: Commercial Auto, Garage Liability PASLA List
Description of Insured’s Operation List of Descriptions
Effective Date
Expiration Date
Multi State Risk Yes/No
Insurer Name and Number
Property Limit - Total Insured Values
Casualty Limit – General or Policy Aggregate Limit
PA Premium – The premium that represents the portion of the risk located in PA
Policy Premium
Revenue Recognition Date – Determines which monthly 1620 and annual RTC-123 the filing will
appear on. This will be determined by entry date.
Tax Exempt Risk Y/N – Must still be filed
Filing Procedure
Within 30 days of the effective date of the placement.
Client emails 1609-PR Producing Agent Affidavit and image of Common and Line of Business
Declaration pages (complete policy is acceptable) to Surplus Lines Associates, LLC. A unique
mailbox will be established for communications (i.e. ClientName@SLTaxes.com)
Surplus Lines Associates will enter the transaction into the PASLA EFS and return any
transactions with errors that cannot be resolved utilizing the data available within 10 days of
receipt.
Transactions will be entered in the current “revenue” month based on their effective date and
date received. For example all transactions received during April, up to the cut-off date, with an
effective date of March or prior will be entered in April “revenue” month. April effectives
received in April will be entered in May.
Within 5 working days of the end of the month Surplus Lines Associates, LLC will provide the
client with a monthly transaction report similar to the example below and an invoice for the
transactions processed by Surplus Lines Associates, LLC during the month. The transaction
report should reconcile to the stamping fee invoice sent to the client by the PASLA on the 7th.
Sample monthly transaction report
1620 Monthly Report
Within 15 working days we will deliver to the client the monthly 1620 report for your review,
approval and signature. Client must return the Monthly 1620 report by the 25 th of the month
for filing of the report with the PASLA.
Annual RTC-123 Report
Within 15 working days from the end of the calendar year, we will deliver to the client for your
review, approval and signature. Client must return an electronic image of the Annual RTC-123
report by the 25th of the month for filing of the report with the PASLA. Client will file the RTC123 report with the PA Dept. of Revenue along with payment of the surplus lines tax.
Assumptions
The procedures are based on the following assumptions. The procedures may require revisions
if additional assumptions are identified or removed.
Client will obtain at least 4 accounts for access to the PASLA EFS
Policies are written with a single eligible insurer
There are no risk purchasing groups or master policies
All required data for entry will be available on the policy common and line of business
declaration pages. Endorsement and cancellation documents will contain the necessary
information for filing (including PA premium if multi-state).
Filings are based on one customer Id and one surplus lines licensee. Refer to #1 and #9
Client will pay monthly Stamping Fee invoice and Annual premium taxes.