Form Uct-8291 - Employer Power Of Attorney Assignment
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1Department of Workforce Development
Unemployment Insurance
EMPLOYER POWER OF ATTORNEY ASSIGNMENT
P.O. Box 7942
Madison, WI 53707-7942
Be Aware That:
,
(the employer), UI Account No.
having its main office located at
,
(Street Address, City, State & Zip Code)
appoints
,
(Telephone Number (Include Area Code))
(Name of Representing Company)
located at
,
(Street Address, City, State & Zip Code)
(Telephone Number (Include Area Code))
as its attorney or representative with full power to represent the employer before the Wisconsin Division of
Unemployment Insurance. This representation applies to all matters affecting unemployment insurance
including, although not limited to, all benefit claims, contributions, refunds, experience rating, hearings and
appeals.
The employer further understands that the Wisconsin Division of Unemployment Insurance maintains
three (3) separate and distinct mailing groups which include, although are not limited to:
Group I
UCB-16
Separation Notice
UCB-23
Eligibility Report
UCB-20
Initial Determination
Group II
UCT-14384-1-E Unemployment Insurance Benefit Charges and Adjustments
Group III
UCB-719
Urgent Request for Wages
UCB-701
Computation of Unemployment Insurance Benefits
UCB-708
Notice of Changed Liability for UI Benefits
UCT-101
Quarterly Contribution Report
UCT101A
Quarterly Contribution/Wage Report
UCT-14384-E
Unemployment Insurance Reserve Fund Balance Statement
UCT-7823
Quarterly Wage Reports
The employer authorizes Groups(s)
to be mailed to the named attorney’s
(List Group Number(s))
above listed address and the remaining Group(s)
to be mailed to its (employer’s)
(List Group Number(s))
main office.
This assignment takes effect on
and takes place of all previous assignments.
(Date - mm/dd/yy)
By the signatures below, the employer known as
,
approves the above directions and voluntarily enters into this assignment on
.
(Date - mm/dd/yy)
Employer Name:
Authorized Signature:
(Date Signed - mm/dd/yy)
Title:
Witnessed By:
(Date Signed - mm/dd/yy)
Title:
UCT-8291 (R. 04/2008)
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