Quarterly Bond Contributions Report

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Employment Security Division
Quarter:
Quarter Ending:
Contributions Section
Employer Account:
500 E. Third Street
Delinquent After:
Carson City, NV 89713-0030
Federal ID Number:
BOND FACTOR:
(775) 684-6330
Employer/DBA/Mailing Address
Quarterly Bond Contributions Report
Quarterly bond contributions are due by law in addition to quarterly unemployment insurance (UI) taxes.
Bond contributions will continue to be collected quarterly until the bonds issued to pay federal loans for
unemployment benefits are fully repaid in late 2017 or early 2018.
Please complete this report to determine the Bond Contributions Amount Due for the quarter stated above.
1. ENTER TAXABLE WAGES PAID THIS QUARTER (Same as LINE 5 on Employer’s Quarterly Report)
If LINE 5 on Report is ZERO (no taxable wages) write “NONE” and return without payment.
x
2. MULTIPLY BY BOND FACTOR (Your assigned Bond Factor written as a decimal)
=
3. BOND CONTRIBUTIONS AMOUNT DUE
-
3a. SUBTRACT CREDIT AMOUNT SHOWN ON BOND BILLING STATEMENT (If applicable)
+
4. ADD $5.00 FOR ONE OR MORE DAYS LATE FILING THIS REPORT
+
5. ADD ADDITIONAL CHARGE AFTER 10 DAYS (
) FOR EACH MONTH/PART OF MONTH LATE
LINE 1 X .001
+
6. ADD INTEREST ON AMOUNT DUE (
) FOR EACH MONTH/PART OF MONTH LATE
LINE 3 X .01
=
7. PAY TOTAL BOND CONTRIBUTIONS AMOUNT DUE (Total LINES 3 through 6)
• Return the completed report, along with a separate check for the Total Bond Contributions Amount Due.
Do not combine UI taxes and bond contributions in the same check.
UI taxes and bond
contributions must be kept separate.
• Make check payable to Employment Security Division. Include your Employer Account Number and
“Bond” on the check memo line. NOTE: Electronic payments are not available for bond contributions.
• Use the enclosed return envelope with blue markings. Otherwise, indicate BOND on the envelope.
Print Contact Name: ___________________________
Telephone Number: _____________________
Date: ________________________
BR Rev 2-15

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