confidential employer information - … employer...please complete and mail or fax us at: -...
TRANSCRIPT
CONFIDENTIAL EMPLOYER INFORMATION TO BE COMPLETED BY EMPLOYER AND/OR ADVISOR
1. LEGAL NAME OF EMPLOYER:
a) ADDRESS:
b) CITY: STATE: ZIP: COUNTY (Imp for trust ID Application):
c) MAILING ADDRESS (If different from above):
d) PHONE: (0) FAX NUMBER:
e) E-MAIL ADDRESS:
2. PERSON TO CONTACT FOR INFORMATION: PHONE: ( ) 3. EMPLOYER TAX ID#: 4. FIDUCIARY BOND (EXISTING PLAN): AMOUNT : 5. DATE OF INCORPORATION OR COMMENCEMENT OF BUSINESS: (M/D/YYYY) 6. STATE OF INCORPORATION: 7. ACCOUNTING BASIS: CASH ACCRUAL FISCAL YEAR END: PAYROLL FREQUENCY: WEEKLY BI WEEKLY MONTHLY 8. BUSINESS ACTIVITY? 9. BUSINESS SIC Code:
21331 Costanso Street Woodland Hills, CA 91364 Telephone: 818-883-5356 Fax: 818-883-5475
10. BUSINESS TYPE: CORPORATION PARTNERSHIP “S” CORPORATION 501(C) 3 TAX EXEMPT SOLE PROPRIETORSHIP ASSOCIATION PROFESSIONAL SERVICE CORPORATION LABOR UNION GOVERNMENT AGENCY 11. LIST OF OFFICERS, DIRECTORS, STOCKHOLDERS AND|OR PARTNERS OF THE COMPANY:
NAME TITLE Designation %OF VOTING
STOCK OWNED
1 Officer
2 Officer
3 Officer
4 Officer
5 Officer
Please complete and mail or fax us at: - 818-883-5475 Tel: - 818-883-5356 E-Mail: - [email protected] Consultants, Inc. 21331 Costanso Street, Woodland Hills, CA 91364
12. PLEASE LIST ALL KEY EMPLOYEES BELOW:
5% OR MORE OWNERS
%OWNED SPOUSE, PARENTS & CHILDREN OF OWNERS (IF COVERED BY PLAN)
RELATIONSHIP TO OWNER
1
2
3
4
OFFICERS EARNING 95,000 OR MORE TITLE
1
2
3
4
13. DO YOU CURRENTLY HAVE OR HAVE YOU EVER HAD ANOTHER PLAN? YES NO (IF YES, PLEASE CHECK WHICH TYPE OF PLAN) PLAN #
SEP/IRA YES NO
PROFIT SHARING PLAN/401K YES NO
MONEY PURCHASE PENSION PLAN YES NO
DEFINED BENEFIT PENSION PLAN YES NO
CAFETERIA PLAN (125 PLAN) YES NO
14. IS THERE A UNION PENSION PLAN? YES NO 15. DO YOU CURRENTLY HAVE ANY OWNERSHIP OF ANY OTHER BUSINESS? YES NO (IF YES, PLEASE LIST COMPANY NAME AND PERCENTAGE OF OWNERSHIP)
COMPANY:
%OF OWNERSHIP:
COMPANY:
%OF OWNERSHIP:
COMPANY:
%OF OWNERSHIP:
COMPANY:
%OF OWNERSHIP:
COMPANY:
%OF OWNERSHIP:
Please complete and mail or fax us at: - 818-883-5475 Tel: - 818-883-5356 E-Mail: - [email protected] Consultants, Inc. 21331 Costanso Street, Woodland Hills, CA 91364
16. IF YOU ARE IN THE ENTERTAINMENT BUSINESS, ARE THERE GUILD PLAN (S) TO WHICH CONTRIBUTIONS ARE
MADE ON YOUR BEHALF? YES NO N|A
(IF YES, PLEASE CHECK TYPE OF CONTRIBUTION) SAG DGA WGA OTHER (PLEASE SPECIFY) 17. IF “YES” ARE ALL CONTRIBUTIONS TO THE GUILD PLAN (S) MADE DIRECTLY BY THE PRODUCER WITHOUT GOING
THROUGH YOUR CORPORATION YES NO N|A
18. DO YOU HAVE ANY LEASED EMPLOYEES? YES NO
IF YES, PLEASE LIST BELOW THE NAMES OF THE PENSION PLANS THAT COVER THESE EMPLOYEES:
19. ACCOUNTANT: PHONE: ( )
a) FIRM: b) ADDRESS: CITY: STATE: ZIP :
c) FAX NUMBER:
20. INVESTMENT ADVISOR: PHONE: ( ) a) FIRM: b) ADDRESS: CITY: STATE: ZIP : 21. TRUSTEES: 22. SOCIAL SECURITY NO. (IF SOLE PROPRIETORSHIP): ANSWERS CONFIRMED BY: TITLE: DATE:(M/D/YY)
Please complete and mail or fax us at: - 818-883-5475 Tel: - 818-883-5356 E-Mail: - [email protected] Consultants, Inc. 21331 Costanso Street, Woodland Hills, CA 91364