Form R1 - Application For Employer Registration
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1
2APPLICATION FOR EMPLOYER REGISTRATION
SOCIAL SECURITY BOARD
CHAPTER 44 LAWS OF BELIZE
SECTION I
OFFICIAL USE ONLY
Employer (Parent / Corporate)
Employer Number:
Name:__________________________________________
Company Reg. Number:___________________
Name of Partner
:____________________________
Sales Tax Number: _______________________
(If any)
House Number.: _____ Street: ______________________
Business Tax Number: ____________________
City/Town: ______________________________________
Start Date:________ /_________ /__________
Day
Month
Year
District:_________________________________________
P.O. Box:________________________________________
Close Date: _______ /________ /___________
Day
Month
Year
Phone Number: __________________________________
Ownership Type (Please indicate
)
E-mail:__________________________________________
Contact Person: __________________________________
Government
Sole Proprietor
Post/Job Title: ___________________________________
Quasi Government
Partnership
Fax Number: ____________________________________
Foreign Owned
Limited Company
NGO/Church
Cooperative
Other (Specify)
Proceed to complete Section II.
SECTION II
OFFICIAL USE ONLY
Business Number:
Business / Branches / Subsidiaries:
Operating Zone:
Business Operation (Please indicate
)
Business Name: __________________________________
House Number.: _____ Street:______________________
Casual
Contract
City/Town: ______________________________________
l
Full Time
Seasona
District:_________________________________________
P.O. Box:________________________________________
Registered Date
_______ /_______ /________
:
Day
Month
Year
Phone Number:__________________________________
E-mail:__________________________________________
Start Date:________ /_________ /__________
Day
Month
Year
Contact Person: __________________________________
Post/Job Title:____________________________________
Close Date: _______ /________ /___________
Day
Month
Year
Industry
:___________________
(Business Activity Description)
_______________________________________________
PLEASE COMPLETE SECTIONS III -IV OVERLEAF
FORM R1 2013
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Parent category: Legal