Form Ui-1 Application For Unemployment Insurance Employer Reserve Account

ADVERTISEMENT

COMMONWEALTH OF KENTUCKY
This form is to determine if an employer is liable for Unemployment Insurance in
Division of Unemployment Insurance
Kentucky.
P. O. Box 948
NO ACTION WILL BE TAKEN AND
Frankfort, Kentucky 40602-0948
THE FORM RETURNED IF NOT
(502) 564-2272
FAX (502) 564-5442
PROPERLY COMPLETED AND
APPLICATION FOR UNEMPLOYMENT INSURANCE
SIGNED.
PART I - IDENTIFICATION AND TYPE OF EMPLOYMENT
EMPLOYER RESERVE ACCOUNT
1. Business Name & Mailing Address:
UI-1 (R. 06/91) (V-3)
Legal Entity Name
Business Name
(To be completed by all employers)
Address
5.
Check type of employment and complete remainder
Of form as indicated.
Address
Acquired all or part of an existing business - Parts II and VI
Address
New Business Employer - Parts II and III
Domestic Employer - Parts II and IV
City
State
Zip Code
Agricultural Employer – Parts II and V
New 501(c)(3) Non-Profit Employer – Part I Only*
2.
Telephone #
(
)
Governmental Entity - Part I Only*
Fax #
(
)
Resumed Employment - Part II
E-Mail
Enter Date Employment Resumed:
3.
Federal Employer ID
* Form UI-1S will be sent to you upon return of this form.
4.
If you have previously been assigned an Unemployment Insurance Number, enter it here:
PART II - GENERAL INFORMATION
6.
Describe MAJOR Business Activity IN KENTUCKY (BE SPECIFIC)
(g)
Agricultural (Type)
(a)
Retail Trade (Product)
(h)
Wholesale Trade (Product)
(b)
Service (Type)
(i)
Manufacturing (Product)
(c)
Construction (Type)
(j)
Mining (Product)
Residential
Non-residential
(k)
Other (Explain)
(d)
Information/Publishing/Broadcasting/Internet
(e)
Finance/Insurance/Real Estate (Product)
(f)
Transportation/Communication/Utilities (Type)
7.
Is this establishment primarily engaged in performing services for other units or locations for this company?
YES
NO
If, “YES”, indicate the nature of activity of this establishment:
(a)
Central Administrative Office
(c)
Storage (warehouse)
(b)
Research, development or testing
(d)
Other (specify)
8.
Identification of Owner, Partners (General or Limited), Corporate Officers, Members, etc. (Attach additional sheet if necessary)
SOCIAL SECURITY NUMBER
FIRST NAME
M.I.
LAST NAME
TITLE
TELEPHONE NO.
RESIDENCE ADDRESS
9.
Name, Mailing Address and Telephone Number of person with payroll records (if different from above):
10.
Type of Organization:
Sole Proprietorship
Partnership
Corporation
LLP
LLC
Other
11.
Provide the following information for each establishment or location in Kentucky:
Physical Location of Business in Kentucky (Street, City, Zip Code)
County
No. of Workers
(If no physical location, please provide home address of employee or work site in Kentucky.)
Check here if you wish to file a separate wage and tax report for each location.
12.
Prior to beginning employment in Kentucky, were you subject in the current or preceding year under the unemployment compensation
law of any other state?
YES
NO
If “YES”, what State:
PART III - NEW BUSINESS EMPLOYMENT (Do not include agricultural or domestic employment!) (INCLUDE CORPORATE OFFICERS!)
13.
Date on which you first employed a worker in Kentucky (month, day, year):
14.
Date you first paid wages in Kentucky (month, day, year):
15.
Have you or do you expect to have a quarterly payroll of at least $1,500.00?
YES
NO
If “YES” in what month and year did (or will) this first occur?
Month
Year
16.
Have you or do you expect to employ at least one worker in 20 different calendar weeks during a calendar year?
YES
NO
If “YES” in what month and year did (or will) the 20th week occur?
Month
Year
Signature:
I hereby affirm that I am authorized to sign this report on behalf of the indicated employer, and further affirm that the information provided herein is
complete and accurate to the best of my knowledge. I understand that I may be subject to the full penalty of the law for knowingly making a false
statement (KRS 341.990).
SIGNATURE
TITLE
DATE

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2