Form Up-1n - Zero Negative Holder Report Form - 2014
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1
2INSTRUCTIONS FOR FORM UP-1N
NEGATIVE REPORTS ARE REQUIRED!
HOLDER INFORMATION:
This form is for holders with no unclaimed property to report.
ITEM 1- Enter your federal employer identification number.
ITEM 2- Enter your business name and mailing address.
ITEM 3- If this report is being prepared by an agent on behalf of the business, enter the agent’s name and
address.
ITEM 4- Enter the name of the person completing the form.
ITEM 5- Enter the telephone number for the person completing the form.
ITEM 6- Enter the electronic mail address for the person completing the form.
ITEM 7- Enter the date your business was incorporated or registered.
ITEM 8- Enter the state where your business is registered or incorporated.
ITEM 9- Enter primary business activity.
ITEM 10- Enter number of employees.
ITEM 11- Enter annual sales/premiums.
ITEM 12- Enter premiums written in Georgia (if applicable)
ITEM 13- Enter total assets.
VERIFICATION:
The report must be certified by a CFO, partner or company officer.
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Parent category: Financial