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UITL-100 Page 2 R 05/2011 15. Did the business entity acquire or hire any workers from the prior business who are now employed with the new business If Yes How many employees were acquired How many employees did the prior business have during its last four pay periods Last Pay Period Third-to-Last Pay Period Fourth-to-Last Pay Period Second-to-Last Pay Period 16. Bank Name and Address provide complete address include city state and ZIP code Payroll-Records Location provide complete address...

If the employer is required to provide coverage to its eligible employed- meet, we will make any reasonable adjustments necessary to make UI coverage affordable so that the employer receives an adequate rate of return on the premiums. As required under the federal Unemployment Insurance Excess Benefit Act (UIGB Act), we will issue you a “Certified State Unemployment Insurance Claim” form for your records and a written receipt. You must include a copy of your application form (including all pages) in any written notice to your employees. Any non-UI-covered employee must provide his/her own documentation (e.g., company tax returns, employment records) to show that his/her wages were paid during the 3 months preceding the month he/she was hired or to show that he/she is being considered jobless under § 401(b)(3) of the Internal Revenue Code. If they fail to provide these documents, the employee will not be eligible for UI. If you have questions regarding this policy, or if you are a victim of a fraudulent claim for unemployment insurance benefits, please call the Colorado Department of Labor and Employment at, or the Colorado Attorney General's Office at. — IMPORTANT NOTICE Regarding Form 8-EZ. These forms have been updated to help you more efficiently apply for unemployment insurance benefits. — COLORADO BUREAU OF REVENUE and COLORADO DEPOSIT INSURANCE — REFUNDS AND EXCLAMATIONS — GENERAL INFORMATION — DEFINITIONS — APPLICATIONS — E-SIGNATURES — EMPLOYER RESPONSIBILITIES — OTHER INFORMATION — UNEMPLOYMENT LOAN INSURANCE — UNEMPLOYMENT INSURANCE AND FAMILY LAW CLAIMS — EXPLANATORY STATEMENTS — PREVIOUS REFERENCES — DEFINITIONS — GENERAL INFORMATION — EXCLUDED EMPLOYERS — APPLICATION FOR UNEMPLOYMENT INSURANCE ACCOUNT and DETERMINATION OF EMPLOYER LIABILITY Complete and mail this application to the address at the top of this page to register your business with us for unemployment insurance (UI) purposes. We will review your application and determine whether you must provide UI coverage for your employees. If the employer is required to provide coverage to its eligible employed- meet, we will make any reasonable adjustments necessary to make UI coverage affordable so that the employer receives an adequate rate of return on the premiums.

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