Form Ems 5203 - Voluntary Election To Extend The Coverage Of The Washington Employment Security Act

ADVERTISEMENT

EMS 5203 (Rev. 1/2000) Com.Code 7540-032-139
STATE OF WASHINGTON
EMPLOYMENT SECURITY DEPARTMENT
U.I. TAX ADMINISTRATION
P.O. Box 9046
OLYMPIA, WA 98507-9046
VOLUNTARY ELECTION TO EXTEND THE COVERAGE OF THE WASHINGTON
EMPLOYMENT SECURITY ACT
Please complete and return this form to the Washington Employment Security Department, UI Tax Administration, P.O. Box 9046, Olympia,
Washington 98507-9046. This agreement to elect coverage becomes binding upon the approval by the agency. If the agreement is
approved, a copy will be returned to you signed by an authorized representative. If your application cannot be approved, you will be notified
of the reason. The Washington Administrative Code (WAC) lists reasons why voluntary coverage may not be approved and why it may
be cancelled after it is approved (see reverse).
Please answer completely each of the following questions:
1.
Business name
2.
Mailing address
3.
If you are already an employer subject under the Washington Employment Security Act, please indicate your Empl. Sec. Reference
No.
, and/or your Unified Business Identifier No.
4.
Provide below the type(s) of non-covered employment in which you presently employ workers whom you wish to cover, the location
of the establishment(s) where the work is performed, and the number of all workers in employment in each such establishment.
Type(s) of Employment to be Covered
No. Employed
(Check one and/or specify)
Corporate Officers G 
 
All Individuals G 
 
Distinct Class of Individuals G 
 
Other (specify)
 
5.
If you represent a corporation, please complete all current corporate officers data requested on the reverse side of this form.
NOTE: For voluntary coverage, the law requires that all corporate officers be covered as a group.
6.
The undersigned, an employer or prospective employer under the Washington Employment Security Act, pursuant to the terms
and provisions of RCW 50.24.160, does hereby voluntarily elect to extend the application of the law to workers in noncovered
employment, and requests written approval of such election by the Employment Security Department of Washington, to be
effective as of:
,
.
(Signature of Authorized Representative)
(Business Phone)
,
.
(Title)
(Date of Application)
7.
This application MUST be signed by someone authorized to bind the employer.
Voluntary Coverage is effective until terminated by the employer or cancelled by the agency. Coverage must remain in effect for a
MINIMUM OF TWO CALENDAR YEARS. A request for termination by the employer must be in writing and postmarked by January
15, immediately following the end of the last year of desired coverage. In the event that your taxes become delinquent, the agency
reserves the right to cancel your Voluntary Coverage.
Approved by the Commissioner of Washington Employment Security Department to become effective from
,
.
,
.
(Date of Approval)
Authorized Representative of the Commissioner
(OVER)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Ems 5203 - Voluntary Election For Unemployment Insurance Coverage Form Ems 5203 - Voluntary Election For Unemployment Insurance Coverage Legal
Form 635_0121 - Voluntary Election To Adopt The Iowa Business Corporation Act Form 635_0121 - Voluntary Election To Adopt The Iowa Business Corporation Act Legal
Voluntary Election To Extend The Coverage Of The Washington Employment Security Act Form Voluntary Election To Extend The Coverage Of The Washington Employment Security Act Form Legal
Form Deed-591 - Voluntary Election To Extend Coverage To Corporate Officers And Limited Liability Company Members Under Minnesota Ui Law Form Deed-591 - Voluntary Election To Extend Coverage To Corporate Officers And Limited Liability Company Members Under Minnesota Ui Law Business
Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Financial
Form Ucs-2 - Voluntary Election To Become An Employer Under The Florida Unemployment Compensation Law Form Ucs-2 - Voluntary Election To Become An Employer Under The Florida Unemployment Compensation Law Financial
Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Financial
Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax* Law Financial
Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax Law Form Rts-2 - Voluntary Election To Become An Employer Under The Florida Reemployment Tax Law Financial
Form 872-r - Special Consent To Extend The Time To Assess Tax Attributable To Items Of An S Corporation Form Form 872-r - Special Consent To Extend The Time To Assess Tax Attributable To Items Of An S Corporation Form Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2