Form Uce-151 - Employer Status Report
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1
2
3UCE-151
(Rev. 12/2016)
Page | 1
DEPARTMENT USE ONLY
UI Account
Number:
L.B.
L.E.
C.H.
L.A.
AREA
RATE
IND.
OWNER
BY
DATE
PARENT NUMBER
EMPLOYER STATUS REPORT
See instructions on page four. The information requested in this report is required to be provided by S.C. Code Ann. § 41-29-150 and
S.C. Code Ann. Regs. 47-15. It will be used only by public officials in the performance of their public duties. Section 6103(d) of the
Internal Revenue Code authorizes IRS to exchange information with us for audits and certifications.
SECTION 1: Employer Contact Information
1.
Legal Name
2. Trade Name (DBA)
3.
Street Address in S.C. (If out of state, provide
3a. City
3b. State
3c. Zip Code
registered agent’s address)
4.
Mailing Address (if different than street address)
4a. City
4b. State
4c. Zip Code
5.
Federal Employer Identification Number (FEIN)
6. Business Telephone
7. Business Fax
8.
Name of Contact:
8a. Title:
8b. Telephone:
st
8c. Email for Tax:
8d. 1
Email for Benefits:
nd
2
Email for Benefits:
SECTION 2: Entity and Ownership Information
9.
Briefly Describe your business activity:
10. NAICS Code(s):
For detailed information on the NAICS coding structure, please visit the U.S. Census
Bureau at:
11. Type of ownership (Check one)
☐
☐ Corporation
☐ Other
Sole Proprietorship
State of Incorporation:
Please Specify:
☐ General Partnership
☐ Limited Liability Company (If the business elected
☐
to be taxed as a corporation (“checked the box”)
Limited Partnership
with the IRS you must submit a copy of your IRS
State of Registration:_
Notice of Acceptance.)
☐
Limited Liability Partnership
State of Organization:
State of Registration:
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