Electronic Filing

Related Information

Electronic Filing Forms

PSLA requires signed copies of the following forms before issuing a Customer ID and/or an EFS Login ID. Please contact AgencyServices@pasla.org if you have questions.

The Pennsylvania Insurance Department requires signed copies of the following items. Please scan and upload a signed image to the Electronic Filing System. Refer to the Procedures Manual for instructions.

  • Current 1609-PR (PDF or Word formats): To be used for surplus lines filings with policy effective dates on or after January 1, 2013. Per Section 1609 of the Surplus Lines Law, "Within 30 days after the surplus lines licensee has placed insurance with an eligible surplus lines insurer, the writing producer must execute and forward to the surplus lines licensee a written statement, in a form prescribed by the department..." The form is the 1609-PR and the licensee must upload the completed signed form to EFS when submitting a 1609-SLL filing.
  • Former 1609-PR (PDF or Word formats): To be used for surplus lines filings with policy effective dates on December 31, 2012 and prior. Per Section 1609 of the Surplus Lines Law, "Within 30 days after the surplus lines licensee has placed insurance with an eligible surplus lines insurer, the writing producer must execute and forward to the surplus lines licensee a written statement, in a form prescribed by the department..." The form is the 1609-PR and the licensee must upload the completed signed form to EFS when submitting a 1609-SLL filing.
  • 1620 Monthly Report (PDF or Excel formats): Per Section 1620 of the Surplus Lines Law, "Within thirty (30) days following the end of each month, each surplus lines licensee shall file with the department, on forms prescribed by the department, a verified report in duplicate of all surplus lines insurance transacted during the preceding month".
  • RCT-123 Annual Tax Report: The Tax Form and instructions are available. The completed form and payment must be sent to the Pennsylvania Department of Revenue. A complete copy of this form must also be uploaded to PSLA via the Electronic Filing System by February 1. Please contact the PA Department of Revenue at 717.783.6031 if you have questions on the RCT-123.

After the above images are uploaded to EFS, PSLA reviews the images for discrepancies. Please review your image before uploading it to EFS to minimize your discrepancies.