Form Uitl-18 - Power Of Attorney (Page 2 of 2) in pdf

INSTRUCTIONS FOR COMPLETING THE POWER OF ATTORNEY

Employer Information

Employer Name: Type or write the entity name or business name.

Trade Name: Type or write the doing-business-as name or trade name.

Employer Account Number: Type or write the 9-digit Colorado unemployment insurance (UI) tax account number. The

power of attorney will not be processed or approved if this account number is not provided.

Street Address, City, State, and ZIP Code: Type or write the entity’s or business's location address.

Purpose of Application

Acceptance of power of attorney: Check this box if you want to name or change an entity or individual to have power of

attorney. If you check this box, you must provide an effective date.

Discontinuation of power of attorney: Check this box if you want to remove or change the entity or individual with power

of attorney. If you check this box, you must provide an effective date.

For all unemployment insurance (UI) information: Check this box if you want to accept or discontinue power of attorney

for all information related to your UI account number.

For UI tax-related information: Check this box if you want to accept or discontinue power of attorney for UI tax-related

information.

For UI benefit claim-related information: Check this box if you want to accept or discontinue power of attorney for UI

benefit claim-related information.

For all distribution points of this account number: Check this box if all the distribution-point accounts, if applicable, for

the employer account shown are affected.

For specific distribution points of this account number: Check this box if only specific distribution-point accounts for the

employer account shown, if applicable, are affected. You must attach a list of the specific distribution-point accounts affected.

Name of Power of Attorney: Type or write the name of the entity or individual you want to accept as the power of attorney.

Do not list an individual employee of a business unless that is the business name.

Mailing-Address Information

Complete Mailing Address: Complete the first section if you are adding, changing, or removing a power of attorney from an

entity or individual. This information must be complete so that the UI Program is informed as to who will be responsible for

UI correspondence. Provide a second mailing address only if you want the claim-related information sent to an address

different than the address for tax-related information.

NOTE: You are responsible for forwarding any UI document that is sent to an incorrect mailing address.

Employer Approval

Employer Signature: You must sign this form, provide your title, and date the form in order to make this a valid document.

Power of Attorney Representative Signature: A representative of the entity or the individual who you want to accept as the

power of attorney must sign this form, provide his or her title, and date the form in order to make this a valid document.

NOTE: A signature is required only of the entity or individual you want to accept as the power of attorney. You do not need a

signature from the entity or individual whose power of attorney is being discontinued.

UITL-18 Reverse (R 08/2006)

Form Uitl-18 - Power Of Attorney Page 2