Looking for a Delaware Department Of Labor Forms And Templates? Download it for free!

Form Uc-1 - Report To Determine Liability And If Liable Application For Employer Account Number - 2017

STATE OF DELAWARE

UC-1-01/17

DEPARTMENT OF LABOR

DIVISION OF UNEMPLOYMENT INSURANCE

P.O. BOX 9953

WILMINGTON, DE 19809-0953

302-761-8482

(DO NOT FILL IN THIS SPACE)

This report is to be filled in and returned to

Employer Number___________________

REPORT TO DETERMINE

this office within 10 days of its receipt

Ind. Code and Area _________________

LIABILITY AND IF LIABLE

whether or not you are liable for

Effective Date of Liability ____________

APPLICATION FOR EMPLOYER

assessment under Part III, Title 19,

Assessment Rate ____________________

ACCOUNT NUMBER

Delaware Code.

Status Date: _______________________

– ALL QUESTIONS MUST BE ANSWERED

FILL IN WITH TYPEWRITER OR PRINT IN INK

Name of Employer and Trade Name, if any:

5. Have you:

☐ 1. Started a new business

☐ 2. Purchased a going business (Attach Explanation)

☐ 3. Just begun having employment

☐ 4. Reorganized (Attach Explanation)

1(a). Federal Employer’s Identification Number:

☐ 5. Other (Attach Explanation)

Street Address and Telephone Number of Main Office:

6. Ownership Information

Is business publicly traded on the stock market?

Yes ☐

No ☐

If yes, provide name, Federal Employer Identification Number

Address to which employer’s report forms and mail are to

and stock exchange symbol of controlling entity:

be sent. Outside representative must file a notarized

power of attorney.

If no, complete ownership information below. If more than one

owner, attach additional information. Percentage of ownership

must total 100%.

3(a). E-Mail Address:

Have you previously filed an application for a Delaware

If owned by another entity, please attach an organizational chart.

U.I. account number? Yes ☐ No ☐

Name:

Social Security Number:

Address:

% of Ownership:

7. On what date did you first have payroll for

8. Are you liable as an employer

9. Do you own or control any other

employees working in Delaware?

under the Unemployment

employing unit in Delaware?

No ☐

Compensation Laws in any other

state?

Yes ☐ Account # ______________

Yes ☐

No ☐

7(a). Will gross payroll meet or exceed $1500.00

If you meet the criteria, do you want to

quarter? Yes ☐ No ☐

in either 3

or 4

combine accounts for rating purposes?

Yes ☐ No ☐

10. State total number of workers in covered employment in Delaware and total payroll by calendar quarter. If unknown, you may

estimate these numbers.

Effective 1/1/96, wages of all corporate officers are reportable.

MARCH

JUNE

SEPT.

DEC.

Employees

Payroll

Employees

Payroll

Employees

Payroll

Employees

Payroll

2013

2014

2015

2016

2017

Form Uc-1 - Report To Determine Liability And If Liable Application For Employer Account Number - 2017

Related Articles

Related forms

Related Categories