Form U11 - Unemployment Insurance Employer Registration - Montana Department Of Labor And Industry Page 2
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312. Name of Person Who Prepares Records and Reports:
Title:
Address
City
State
ZIP Code
Telephone Number
Cell Number
Fax Number
Email
13. Name of Accountant:
Address
City
State
ZIP Code
Telephone Number
Cell Number
Fax Number
Email
14. DESCRIPTION OF BUSINESS TYPE AND ACTIVITY IN MONTANA: This section MUST BE COMPLETED in detail to accurately determine your
business activity for proper assignment of contribution rates. Be specific and CHECK ALL THAT APPLY. Generalities could result in assignment
of a higher contribution rate.
Agriculture, Forestry, Fishing
Mining
Construction
Wholesale Trade
Retail Trade
Services
Transportation, Communication & Public Utilities
Finance, Insurance, Real Estate
Manufacturing
Primary Activity
Specific Product or Service
% of Gross Income
# MT Employees
15. Does this establishment have employment at more than one physical location in Montana? Yes
No
Exclude construction and contract work site if less than six (6) months in duration.
If yes, provide the address, city and ZIP Codes of all other Montana locations.
Name of contact person and phone number:
16. Will you have any out-of-state employees?
Yes
No. If Yes, in what other states do they work?
17. Date wages first paid in Montana:
Will your total payroll for the current year equal or exceed $1,000?
Yes
No
The date and year payroll first equaled or exceeded $1,000:
18. Supply the following information concerning wages paid by the current owner in Montana during the current and/or preceding year(s) – if information is
unavailable, leave blank:
YEARS:
To Date in 2018
2017
2016
2015
2014
2013
Wages You Paid Each Year:
19. Are you required to pay Federal Unemployment Tax (FUTA)?
Yes
No
20. Complete this section only if you are a governmental entity, Indian tribe or wholly-owned entity of an Indian tribe, or a 501(c)(3) tax exempt
organization.
Select one of the following payment options:
Reimbursement of benefit payments attributable to employment with your organization.
Experience Rated (payment of contributions) on your quarterly taxable payroll at the rate applicable for new employers.
** Default is Experience Rated: 1) If section is not completed, and 2) you have not provided an IRS exemption letter.
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UI1 (Rev. 1/2/2018)
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