Form Cg-100-C - Checklist For Applications Cg-100-A, Cg-100-W, And Cg-100-V Page 2
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You must supply proof of workers’ compensation and disability insurance for your employees.
If you do not intend to have employees, you must complete and submit an application to the
New York State Workers’ Compensation Board on Form CE-200, Certificate of Attestation of
Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance
Coverage. Important: They will process your application and mail you a certificate of attestation of
exemption. This process may take up to four weeks for completion.
Note: To obtain an exemption form immediately, the Workers’ Compensation Board recommends
that you apply using their Web-based application and complete Form CE-200 online at
You will be able to complete the application and print the required
certificate.
Copies of purchase contract(s) and all related documents, if the applicant is purchasing an
existing business.
After we review your application, we may require you to submit a performance bond in the
amount of $10,000. This is required of wholesale dealer applicants, including agents who are
also wholesale dealers. The performance bond is not required of wholesale applicants who
operate only vending machines (Form CG-100-V).
Applicants for an agent license must include letters from at least two cigarette manufacturers in
the New York State cigarette market, stating that they agree to furnish cigarettes to the applicant
once licensed. However, this is generally not required if the applicant is a manufacturer, and in
certain other instances.
If you are not currently registered for New York State sales tax, you may apply online at
for a Sales Tax Certificate of Authority. (For additional information, see Need
help? below.) Cigarette agent and cigarette wholesale dealer licenses are conditioned upon the
applicant having and maintaining an active sales tax registration.
Form CG-100-P, Personal Questionnaire, for each owner, officer, shareholder, or any other person
who meets the definition of a controlling person.* You can mail these separately if the controlling
person desires confidentiality.
The following documents must be included with Form CG-100-P:
• Certified proof of U.S. citizenship or eligibility to obtain employment in the United States.
• A photocopy of a driver’s license or non-driver ID for each person required to file a
questionnaire.
• Two identical, natural color photographs of yourself taken within 30 days of filing this application.
The photos must have a white background, be unmounted, printed on thin paper, and in
addition, they must be glossy and not retouched. The photo should show a three-quarter
frontal profile showing the right side of your face, with your right ear visible and with your head
bare (unless you are wearing a headdress as required by a religious order of which you are a
member). The photos should be no smaller than 2 x 2 inches, with the distance from the top of
the head to just below the chin about 1¼ inches. Lightly print your social security number on the
back of each photo with a pencil.
Fingerprinting completed at an authorized location. You may find authorized locations and
schedule appointments by going online to or by calling toll free,
1-877-472-6915. The fingerprinting search fee is $75.00. The L-1 vendor fee is $11.75 as of
January 1, 2010. (This fee is subject to change.) You can make payments by check, money order,
credit card, or an L-1 escrow account.
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