Form Er-68 - Application For Partial Transfer Of Experience
Download a blank fillable Form Er-68 - Application For Partial Transfer Of Experience in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Er-68 - Application For Partial Transfer Of Experience with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1APPLICATION FOR PARTIAL TRANSFER OF EXPERIENCE
SCHEDULE C
Allocation of Benefit Charge Totals (Claims)
We, the undersigned, do hereby certify that the information given below is, to the best of our
knowledge, true and correct, and we submit said information as part of the Application for Partial
Transfer of Experience under Section 1507 B of the Illinois Unemployment Insurance Act
TRANSFEREE
TRANSFEROR
Employer Account No. __________________
Employer Account No.___________________
Business Name ________________________
Business Name ________________________
Signed By ____________________________
Signed By ____________________________
Official Title __________________________
Official Title __________________________
Date Signed __________________________
Date Signed __________________________
1
2
3
4
Total Benefit Charges
Balance of
PERIOD COVERED BY
under
Benefit Charges
Benefit Charges
STATEMENT OF BENEFIT CHARGES
PREDECESSOR’s
Atrributable to
Attributable to
FORM BEN-118, ISSUED
Account Number
TRANSFEREE
TRANSFEROR
(Col. 2 less Col. 3)
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
From:
To:
ER-68 (Rev. 3/05)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Partial Transfer Of Experience - Illinois Department Of Employment Security - 2010
Financial
Application And Agreement For Partial Transfer Of Experience Rating Record Form - Louisiana Department Of Labor
Legal
Form Es-963a - Successor's Application For Partial Transfer Of Predecessor's Experience History - New Mexico Department Of Labor
Legal
Form Application And Agreement For Partial Transfer Of Experience Rating Record - Louisiana Department Of Labor
Legal
Application And Agreement For Partial Transfer Of Experience Rating Record Form - Louisiana Workforce Commission
Legal
Form Es-963a - Successor's Application For Partial Transfer Of Predecessor's Experience History
Legal
Related Categories
Parent category: Financial