This form contains 165 fields organized into 33 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Business Identification
Federal Employer Identification Number Text
Provide the Federal Employer Identification Number (FEIN) for the business.
Ownership Began Month Text
Enter the two-digit month when the business ownership began.
Max length: 2 characters
Ownership Began Day Text
Enter the two-digit day when the business ownership began.
Max length: 2 characters
Ownership Began Year Text
Enter the four-digit year when the business ownership began.
Max length: 4 characters
Change in Status Report
Report a Change in Status: Business Ownership, Entity Type, or Name Radiobutton
Check this box if you are reporting a change in the business ownership, entity type, or name.
Reason for Change Text
Enter the reason for the change in status. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Change From Text
Enter the previous status before the change. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Change To Text
Enter the new status after the change. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Effective Change Month Text
Enter the month for the effective date of change. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Max length: 2 characters
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Effective Change Day Text
Enter the day for the effective date of change. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Max length: 2 characters
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Effective Change Year Text
Enter the year for the effective date of change. Fill only if 'Report a Change in Status: Business Ownership, Entity Type, or Name' is 'Yes'.
Max length: 4 characters
Depends on: Report a Change in Status: Business Ownership, Entity Type, or Name
Close Employer Account Request
Close Employer Account Radiobutton
Check this box if you are requesting to close your employer account.
No longer have employees Radiobutton
Check this box if the reason for closing your employer account is that you no longer have any employees. Fill only if 'Close Employer Account' is 'Yes'.
Depends on: Close Employer Account
Out of Business Radiobutton
Check this box if the reason for closing your employer account is that your business is no longer operating. Fill only if 'Close Employer Account' is 'Yes'.
Depends on: Close Employer Account
Day of Last Payroll Text
Provide the day of the last payroll for the employer account being closed. Fill only if 'Close Employer Account' is 'Yes'.
Max length: 2 characters
Depends on: Close Employer Account
Month of Last Payroll Text
Provide the month of the last payroll for the employer account being closed. Fill only if 'Close Employer Account' is 'Yes'.
Max length: 2 characters
Depends on: Close Employer Account
Year of Last Payroll Text
Provide the year of the last payroll for the employer account being closed. Fill only if 'Close Employer Account' is 'Yes'.
Max length: 4 characters
Depends on: Close Employer Account
Co-Ownership Employment Eligibility
Yes, I only employ my minor children (under 18) Radiobutton
Check this box if you only employ your minor child(ren) (under 18) and are not subject to UI and SDI but may be subject to PIT. Fill only if 'Co-Ownership' is 'Yes'.
Depends on: Co-Ownership
No, I do not only employ my minor children (under 18) Radiobutton
Check this box if you do not only employ your minor child(ren) (under 18). Fill only if 'Co-Ownership' is 'Yes'.
Depends on: Co-Ownership
Contact Person Information
Contact Person Name Text
Enter the full name of the contact person.
Contact Person Phone Number Text
Enter the contact person's phone number.
Max length: 14 characters
Contact Person Email Text
Enter the contact person's email address.
Contact Person Relation Text
Enter the relationship of the contact person to the business.
Contact Person Address Text
Enter the complete mailing address for the contact person.
Declaration
Declaration Date Date
Enter the date of the declaration.
Max length: 10 characters
Signer Name Text
Enter the full name of the individual making the declaration.
Signer Title Text
Enter the job title or position of the individual making the declaration.
Signer Phone Number Text
Enter the phone number of the individual making the declaration.
Max length: 14 characters
Doing Business As
Doing Business As Name Text
Please provide the legal name under which the business operates, if different from the registered legal name.
E-Mail Information
Check to allow e-mail contact Checkbox
Check this box if you wish to allow contact via e-mail.
Email Address Text
Please provide a valid email address for correspondence.
Employer Type
COMMERCIAL Radiobutton
Check this box if your employer type is Commercial.
PACIFIC MARITIME Radiobutton
Check this box if your employer type is Pacific Maritime.
FISHING BOAT Radiobutton
Check this box if your employer type is Fishing Boat.
Existing Employer Account Number
Existing Employer Account Number Segment 1 Text
Please enter the first segment of the existing employer account number. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member', 'Report a Purchase of Business', 'Report a Sale of Business', 'Reopen a Previously Closed Account', 'Close Employer Account', 'Report a Change in Status: Business Ownership, Entity Type, or Name' is selected, any.
Max length: 3 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member, Report a Purchase of Business, Report a Sale of Business, Reopen a Previously Closed Account, Close Employer Account, Report a Change in Status: Business Ownership, Entity Type, or Name
Existing Employer Account Number (first digit of first 3 digits) Text
Enter the first digit of the first three digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number (second digit of first 3 digits) Text
Enter the second digit of the first three digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number (third digit of first 3 digits) Text
Enter the third digit of the first three digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number Segment 2 Text
Please enter the second segment of the existing employer account number. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member', 'Report a Purchase of Business', 'Report a Sale of Business', 'Reopen a Previously Closed Account', 'Close Employer Account', 'Report a Change in Status: Business Ownership, Entity Type, or Name' is selected, any.
Max length: 4 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member, Report a Purchase of Business, Report a Sale of Business, Reopen a Previously Closed Account, Close Employer Account, Report a Change in Status: Business Ownership, Entity Type, or Name
Existing Employer Account Number (first digit of middle 4 digits) Text
Enter the first digit of the middle four digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number (second digit of middle 4 digits) Text
Enter the second digit of the middle four digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number (third digit of middle 4 digits) Text
Enter the third digit of the middle four digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number (fourth digit of middle 4 digits) Text
Enter the fourth digit of the middle four digits of your existing employer account number.
Max length: 1 characters
Existing Employer Account Number Segment 3 Text
Please enter the third segment of the existing employer account number. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member', 'Report a Purchase of Business', 'Report a Sale of Business', 'Reopen a Previously Closed Account', 'Close Employer Account', 'Report a Change in Status: Business Ownership, Entity Type, or Name' is selected, any.
Max length: 1 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member, Report a Purchase of Business, Report a Sale of Business, Reopen a Previously Closed Account, Close Employer Account, Report a Change in Status: Business Ownership, Entity Type, or Name
First Corporate Officer Information
First Corporate Officer Name Text
Please enter the full name of the first corporate officer, partner, or LLC member. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
First Corporate Officer Title Text
Please enter the title of the first corporate officer, partner, or LLC member. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
First Corporate Officer SSN Text
Please enter the Social Security Number of the first corporate officer, partner, or LLC member. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 11 characters
Depends on: Corporation
First Corporate Officer CA Driver License Number Text
Please enter the California Driver License Number of the first corporate officer, partner, or LLC member. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 8 characters
Depends on: Corporation
Add First Corporate Officer Radiobutton
Check this box if you are adding a new first corporate officer, partner, LLC member, manager, or officer to the company's records. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Change First Corporate Officer Radiobutton
Check this box if you are updating or changing existing information for the first corporate officer, partner, LLC member, manager, or officer. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Delete First Corporate Officer Radiobutton
Check this box if you are removing the first corporate officer, partner, LLC member, manager, or officer from the company's records. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
First Individual Owner Information
First Owner Name Text
Please enter the full name of the first individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Depends on: Individual Owner
First Owner Title Text
Please enter the title of the first individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Depends on: Individual Owner
First Owner SSN Text
Please enter the Social Security Number of the first individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Max length: 11 characters
Depends on: Individual Owner
First Owner CA Driver License Number Text
Please enter the California Driver License number of the first individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Max length: 8 characters
Depends on: Individual Owner
Add Owner/Co-Owner Radiobutton
Check this box if you are adding new information for an individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Depends on: Individual Owner
Change Owner/Co-Owner Radiobutton
Check this box if you are changing existing information for an individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Depends on: Individual Owner
Delete Owner/Co-Owner Radiobutton
Check this box if you are deleting information for an individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Individual Owner'.
Depends on: Individual Owner
First Payroll Date
First Payroll Date Month Text
Enter the two-digit month for the first payroll date.
Max length: 2 characters
First Payroll Date Day Text
Enter the two-digit day for the first payroll date.
Max length: 2 characters
First Payroll Date Year Text
Enter the four-digit year for the first payroll date.
Max length: 4 characters
Form Actions
PRINT Button
Click this button to print the form.
Fourth Corporate Officer Information
Fourth Corporate Officer's Name Text
Enter the full name of the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Fourth Corporate Officer's Title Text
Enter the official title of the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Fourth Corporate Officer's SSN Text
Enter the Social Security Number (SSN) of the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 11 characters
Depends on: Corporation
Fourth Corporate Officer's CA Driver License Number Text
Enter the California Driver License Number of the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 8 characters
Depends on: Corporation
Add Radiobutton
Check this box to add information for the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Change Radiobutton
Check this box to change existing information for the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Delete Radiobutton
Check this box to delete information for the fourth corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Individual Owner Employment Eligibility
Employ Spouse, Parents, or Minor Child (Yes) Radiobutton
Check this box if you only employ your spouse, parent(s), or minor child(ren) (under 18). Fill only if 'Individual Owner' is 'Yes'.
Depends on: Individual Owner
Employ Spouse, Parents, or Minor Child (No) Radiobutton
Check this box if you employ individuals other than your spouse, parent(s), or minor child(ren) (under 18). Fill only if 'Individual Owner' is 'Yes'.
Depends on: Individual Owner
Industry Activity
Specific Product/Services Description Text
Please provide a detailed description of your specific products or services.
Services Radiobutton
Check this box if your primary business industry involves providing services.
Retail Radiobutton
Check this box if your primary business industry is retail, involving the sale of goods directly to consumers.
Wholesale Radiobutton
Check this box if your primary business industry is wholesale, involving the sale of goods in large quantities to retailers or other businesses.
Manufacturing Radiobutton
Check this box if your primary business industry involves the production of goods from raw materials or components.
Temporary Services Radiobutton
Check this box if your primary business industry provides temporary staffing or services.
Leasing Employer Radiobutton
Check this box if your business operates as a leasing employer, providing employees to other businesses.
Professional Employer Organization Radiobutton
Check this box if your business is a professional employer organization (PEO), providing comprehensive HR and payroll services to other businesses.
Other (Specify) Radiobutton
Check this box if your primary business industry is not listed above and specify it in the provided space.
Other Industry Text
If 'Other' is selected for the business industry, please specify your industry. Fill only if 'Other (Specify)' is 'Yes'.
Depends on: Other (Specify)
Legal Name of Organization
Legal Name of Organization Text
Provide the legal name of the organization exactly as it appears on official registration documents. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Location of Employee Services
Employees Working in California - Yes Radiobutton
Check this box if you have employees working in California.
Employees Working in California - No Radiobutton
Check this box if you do not have employees working in California.
Employees Residing in CA, Working Outside CA - Yes Radiobutton
Check this box if you have employees who reside in California but work outside of California.
Employees Residing in CA, Working Outside CA - No Radiobutton
Check this box if you do not have employees who reside in California and work outside of California.
Mailing Address
Same as above Checkbox
Check this box if the mailing address is the same as the physical business location provided in Section O.
Mailing Street Number Text
Please enter the street number for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing Street Name Text
Please enter the street name for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing Unit Number Text
Please enter the unit number for the mailing address if applicable. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing City Text
Please enter the city for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing State/Province Text
Please enter the state or province for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing ZIP Code Text
Please enter the ZIP code for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing Country Text
Please enter the country for the mailing address. Fill only if 'Same as above' is 'No'.
Depends on: Same as above
Mailing Phone Number Text
Please enter the phone number associated with the mailing address. Fill only if 'Same as above' is 'No'.
Max length: 14 characters
Depends on: Same as above
Partnership Employment Eligibility
Yes Radiobutton
Check this box if your partnership (consisting of siblings only) only employs your parent(s). Fill only if 'General Partnership' is 'Yes'.
Depends on: General Partnership
No Radiobutton
Check this box if your partnership (consisting of siblings only) employs individuals other than only your parent(s). Fill only if 'General Partnership' is 'Yes'.
Depends on: General Partnership
Physical Business Location
Street Number Text
Enter the street number of the physical business location.
Street Name Text
Enter the street name of the physical business location.
Unit Number Text
Enter the unit number of the physical business location, if applicable.
City Text
Enter the city of the physical business location.
State or Province Text
Enter the state or province of the physical business location.
ZIP Code Text
Enter the ZIP code of the physical business location.
Country Text
Enter the country of the physical business location.
Business Phone Number Text
Enter the business phone number for the physical business location.
Max length: 14 characters
Purchase of Business Report
Report a Purchase of Business Radiobutton
Check this box if you are reporting the purchase of a business.
Purchase Date Month Date
Enter the month of the business purchase date. Fill only if 'Report a Purchase of Business' is 'Yes'.
Max length: 2 characters
Depends on: Report a Purchase of Business
Purchase Date Day Date
Enter the day of the business purchase date. Fill only if 'Report a Purchase of Business' is 'Yes'.
Max length: 2 characters
Depends on: Report a Purchase of Business
Purchase Date Year Date
Enter the year of the business purchase date. Fill only if 'Report a Purchase of Business' is 'Yes'.
Max length: 4 characters
Depends on: Report a Purchase of Business
Purchase Price Number
Enter the total monetary amount paid for the business. Fill only if 'Report a Purchase of Business' is 'Yes'.
Max length: 12 characters
Depends on: Report a Purchase of Business
Entire Business Purchase Radiobutton
Check this box if the reported purchase involved the entire business. Fill only if 'Report a Purchase of Business' is 'Yes'.
Depends on: Report a Purchase of Business
Partial Business Purchase Radiobutton
Check this box if the reported purchase involved only a partial part of the business. Fill only if 'Report a Purchase of Business' is 'Yes'.
Depends on: Report a Purchase of Business
Register for New Employer Account
Register for a New Employer Account Number Radiobutton
Check this box if you want to register for a new employer account number.
Reopen Previously Closed Account
Reopen a Previously Closed Account Radiobutton
Check this box if you are reopening an employer account that was previously closed and provide the previous employer account number.
Request Account for CalJOBS
Request Account for CalJOBS Radiobutton
Check this box if you wish to request an account for CalJOBS.
Sale of Business Report
Report a Sale of Business Radiobutton
Check this box if you are reporting the sale of a business.
Sale Month Date
Enter the month when the business was sold. Fill only if 'Report a Sale of Business' is 'Yes'.
Max length: 2 characters
Depends on: Report a Sale of Business
Sale Day Date
Enter the day when the business was sold. Fill only if 'Report a Sale of Business' is 'Yes'.
Max length: 2 characters
Depends on: Report a Sale of Business
Sale Year Date
Enter the year when the business was sold. Fill only if 'Report a Sale of Business' is 'Yes'.
Max length: 4 characters
Depends on: Report a Sale of Business
Entire Business Sold Radiobutton
Check this box if the entire business was sold. Fill only if 'Report a Sale of Business' is 'Yes'.
Depends on: Report a Sale of Business
Partial Business Sold Radiobutton
Check this box if only a portion of the business was sold. Fill only if 'Report a Sale of Business' is 'Yes'.
Depends on: Report a Sale of Business
Second Corporate Officer Information
Second Corporate Officer Name Text
Enter the full name of the second corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Second Corporate Officer Title Text
Enter the official title of the second corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Second Corporate Officer SSN Text
Provide the Social Security Number (SSN) of the second corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 11 characters
Depends on: Corporation
Second Corporate Officer CA Driver License Number Text
Enter the California Driver License number of the second corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 8 characters
Depends on: Corporation
Add Second Corporate Officer Radiobutton
Check this box if you are adding a second corporate officer, partner, LLC member, or manager to the form. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Change Second Corporate Officer Radiobutton
Check this box if you are changing information for a second corporate officer, partner, LLC member, or manager on the form. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Delete Second Corporate Officer Radiobutton
Check this box if you are deleting a second corporate officer, partner, LLC member, or manager from the form. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Second Individual Owner Information
Second Owner Name Text
Please provide the full name of the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Depends on: Co-Ownership
Second Owner Title Text
Please provide the title or position of the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Depends on: Co-Ownership
Second Owner SSN Text
Please provide the Social Security Number of the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Max length: 11 characters
Depends on: Co-Ownership
Second Owner CA Driver License Number Text
Please provide the California Driver License number for the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Max length: 8 characters
Depends on: Co-Ownership
INDIVIDUAL OWNER/CO-OWNER INFORMATION (2)_Add Radiobutton
Select this option to add information about the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Depends on: Co-Ownership
INDIVIDUAL OWNER/CO-OWNER INFORMATION (2)_Chg Radiobutton
Select this option if you are changing the information of the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Depends on: Co-Ownership
INDIVIDUAL OWNER/CO-OWNER INFORMATION (2)_Del Radiobutton
Select this option if you are deleting the information of the second individual owner or co-owner. Fill only if 'TAXPAYER TYPE' is 'Co-Ownership'.
Depends on: Co-Ownership
State Registration Information
State or Province of Incorporation Text
Please provide the state or province where the business was incorporated or organized. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
California Secretary of State Entity Number Text
Please provide the entity number assigned by the California Secretary of State. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 12 characters
Depends on: Corporation
Taxpayer Type
Individual Owner Radiobutton
Check this box if the taxpayer is an individual owner.
Limited Partnership Radiobutton
Check this box if the taxpayer is a limited partnership.
Joint Venture Radiobutton
Check this box if the taxpayer is a joint venture.
Co-Ownership Radiobutton
Check this box if the taxpayer is a co-ownership.
Association Radiobutton
Check this box if the taxpayer is an association.
Receivership Radiobutton
Check this box if the taxpayer is a receivership.
General Partnership Radiobutton
Check this box if the taxpayer is a general partnership.
Limited Liability Company (LLC) Radiobutton
Check this box if the taxpayer is a Limited Liability Company (LLC).
Estate Administration Radiobutton
Check this box if the taxpayer is an estate administration.
Corporation Radiobutton
Check this box if the taxpayer is a corporation.
Limited Liability Partnership (LLP) Radiobutton
Check this box if the taxpayer is a Limited Liability Partnership (LLP).
Trusteeship Radiobutton
Check this box if the taxpayer is a trusteeship.
Other (Specify) Radiobutton
Check this box if the taxpayer type is not listed and then specify the type in the provided space.
Other Taxpayer Type Text
Specify the taxpayer type if the 'Other' option is selected. Fill only if 'Other (Specify)' is 'Yes'.
Depends on: Other (Specify)
Third Corporate Officer Information
Third Corporate Officer Name Text
Enter the full legal name of the third corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Third Corporate Officer Title Text
Enter the official title of the third corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Third Corporate Officer SSN Text
Enter the Social Security Number of the third corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 11 characters
Depends on: Corporation
Third Corporate Officer CA Driver License Number Text
Enter the California Driver License Number of the third corporate officer, partner, LLC member, or manager. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Max length: 8 characters
Depends on: Corporation
Add Third Corporate Officer Radiobutton
Check this box if you are adding information for the third corporate officer. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Change Third Corporate Officer Radiobutton
Check this box if you are changing existing information for the third corporate officer. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Delete Third Corporate Officer Radiobutton
Check this box if you are deleting the third corporate officer from the records. Fill only if 'TAXPAYER TYPE' is 'Corporation'.
Depends on: Corporation
Update Account Information
Update Address Radiobutton
Check this box if you are updating the physical or mailing address for the employer account.
Update DBA Radiobutton
Check this box if you are updating the Doing Business As (DBA) name for the employer account.
Personal Name Change Radiobutton
Check this box if the personal name associated with the employer account has changed.
Update Officer/Partner/Member Radiobutton
Check this box if you are adding, changing, or deleting an officer, partner, or member of the business.
Effective Date Month Number
Provide the two-digit month for the effective date of the update. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member' is selected, any.
Max length: 2 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member
Effective Date Day Number
Provide the two-digit day for the effective date of the update. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member' is selected, any.
Max length: 2 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member
Effective Date Year Number
Provide the four-digit year for the effective date of the update. Fill only if 'Update Address', 'Update DBA', 'Personal Name Change', 'Update Officer/Partner/Member' is selected, any.
Max length: 4 characters
Depends on: Update Address, Update DBA, Personal Name Change, Update Officer/Partner/Member