DIVISION OF REVENUE AND TAXATION

Transcription

1 WLH H H SLS VS VU WLH H H L SL SLS Business License pplication equirements License pplication Worker s ompensation pplication -Status (on-us) nnual orporate eport rticles & By-Laws (orporation) artnership greement & egistration LL ertificates of rganization rticles of rganization Sketch of Business Location riginal Business License SL SH LL - ew enewal ew enewal ew enewal ew enewal ew enewal ote: ny box marked with an indicates a required document that must be submitted with the application. n addition, applicants must provide a copy of their passport. SHUL S: Banks $ ffshore Banking 1, Security ealers nsurance: ompany $ Broker gent anufacturers $ Wholesalers Scuba iving nstruction $ Scuba iving our peration General Business (per activity) $ ublic Utilities $ oadside Vendors $ 5.00 (Selling Local gricultural & ishery roducts LY ) orm: BUSL age 1 ote: his revision is effective ovember 2015

2 WLH H H SLS VS VU WLH H H L SL SLS pplication for Business License. Y L W WL - BUSSS LS.: (heck below) Y'S...: L LY... (): S Y : dditional location dditional line(s) of business (please specify below) hange of location equest for duplicate license(s) dd.b.. hange of business name B. L 1. orm of business and name of applicant Sole roprietorship artnership orporation (check if foreign corporation) LL Joint Venture ther (please specify) 2. ailing address: elephone: ax: 3. mail address:. L(S) BUSSS L (list every activity location separately) Line of Business B (assumed name) sland Village Lot o f the applicant is a foreign corporation or a on- resident, please specify the name of the registered/resident agent below. ame: ailing address: elephone o.:. L L declare under penalty of perjury that the information above are true and correct and that have complied with all laws and regulations for purposes of obtaining a business license. his declaration is made on this day of at rint applicant's name Signature itle ate L US LY he applicant is is not recommended for approval for the issuance of a business license. eviewed by: pproved by: License o. ate: License fee paid: $ ate paid: riginal: Business License ffice Yellow: Workers ompensation ffice ink: pplicant orm: BUSL age 2 ote: his revision is effective ovember 2015

3 WLH H H SLS VS VU SLS WLH H H L SL Business License pplication Business Location ap of Business Location (i.e., street name, village, etc...) hysical Location of Business orm: BUSL age 3 ote: his revision is effective ovember 2015

4 epartment of ommerce WKS S SS WLH H H SLS.. Box 5795 HB, Saipan el: (670) /8024 ax (670) Website: pplication for ertificate of learance lease take notice that pursuant to the Workers' ompensation Law, as amended, every employer in the ommonwealth is required to secure insurance coverage for employee(s) in case of occupational injury, illness, or death. he law further requires that all applicants for business licenses in the (whether its an application for a new business or the renewal for an existing business) must obtain a ertificate of learance from the Workers' ompensation ommission before the Secretary of inance will issue such business license. ame of Business: ddress: ame of pplicant/epresentative:. LS K H (S) BLW. BUSSS LS L - W: am not an employer now. do, however, understand the requirement of the Workers' ompensation Law. f hire any employee in the future, will comply with the requirements as mandated by law, and immediately secure coverage for my employee(s) and will file a ertificate of ompliance within 30 days thereafter. am an employer or will be hiring personnel within a few days. am providing a copy of the workers' compensation insurance policy in effect and a ertificate of ompliance ( W- 00) as required. have never been an employer operating under a different name. B. BUSSS LS L - WL: have renewed the workers' compensation insurance coverage. am providing a copy of the workers' compensation insurance policy in effect and a ertificate of ompliance ( W-100) as required. did not or no longer have any personnel employed by the business. Signature of pplicant or epresentative ate Saipan Branch: W-101 (V 6/96) inian Branch: ota Branch:

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