Form Ul-1 M - Unemployment Insurance Special Mailing Form

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STATE OF ILLINOIS
Ul-1 M
DEPARTMENT OF EMPLOYMENT SECURITY
401 SOUTH STATE STREET
CHICAGO, ILLINOIS 60605-2280
UNEMPLOYMENT INSURANCE SPECIAL MAILING FORM
If you want correspondence sent to an address other than your business address, please fill out this form completely.
Illinois U.I. account number (if known) ________________________
Place a check before the form that you would like mailed to another address and fill out the following information:
FIRST MAILING ADDRESS
Corporate Headquarters or Authorized Agent
Check form
______ UI-3/40 (Contribution and Wage Report)
Doing Business as Name
______ BEN-118/118R (Statement of Benefit Charges)
______ Rate Notice
C/O
Attn
______ BIS-32 (Notice to Chargeable Employer)
Address
Unit or Suite
City
State
Zip
Country
Telephone No.
SECOND MAILING ADDRESS
Corporate Headquarters or Authorized Agent
Check form
______ UI-3/40 (Contribution and Wage Report)
Doing Business as Name
______ BEN-118/118R (Statement of Benefit Charges)
______ Rate Notice
C/O
Attn
______ BIS-32 (Notice to Chargeable Employer)
Address
Unit or Suite
City
State
Zip
Country
Telephone No.
If more than two mailing addresses are required, attach correspondence. Please follow the above format when requesting additional
mailing addresses.
If any of the above forms are to be mailed to your authorized representative, you must complete the Power of Attorney form which
is on the reverse side of this form.
.....................................................................................................................................................................................................................................................................................
If you want to remove or change a mailing address, complete the section below.
FROM: _______ UI-3/40
TO:
_______ UI-3/40
_______ BEN-118/118R
_______ BEN-118/118R
_______ Rate Notice
_______ Rate Notice
_______ BIS-32
_______ BIS-32
C/O
Attn
C/O
Attn
Address
City
State
Address
City
State
Zip
Country
Telephone No.
Zip
Country
Telephone No.
Termination Date ________________________________________ Effective Date _____________________________________
If the new address is an authorized representative, you must complete a Power of Attorney form.
Signed __________________________________________________ Date ___________________________________________

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