UCE-101-S (Rev. 12/6/18)  
                                                                                   
                                                                                         EMPLOYER REPORT OF 
                  P.O. Box 995 Columbia, SC 29202                                        CHANGE TO ACCOUNT 

                  803-737-2400 | www.dew.sc.gov   
 Tired of paperwork? We can help! Make Changes to your Unemployment Insurance tax account online. It’s fast, easy, accurate, and secure! 
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                                                      EMPLOYER INFORMATION 
  Business Name:__________________________________________  DEW Account Number:___________________   FEIN:____________________ 
                                                          CHANGES TO ACCOUNT 

  Effective Date of Changes being made (mm/dd/yyyy):________________________ 
   
     1.   Add/Remove Owner/Officer (Individual changes within the organization which DO NOT change the entity.). 
          Name                        SSN           Title             Ownership %           Home Address                             ADD or REMOVE 
   
                                                                                                                                      Add        Remove 
                                                                                                                                      Add        Remove 
                                                                                                                                      Add        Remove 
  
     2.   Change of Physical Location. 
                   Storefront/Physical Location                        Job/Construction Site                      Employee Residence 

                  (Location Address)                                  (City)                                     (State)             (Zip Code) 
     3.   Change in Mailing Address. 
                                                                                                                           
                  (Address or PO Box)                                    (City)                                  (State)             (Zip Code) 
                                                                                          Please attach the documents filed with 
     4.   Change in Legal Business Name to: _________________________________             the Secretary of State verifying change. 
        
     5.   Business in South Carolina continues in operation without employment.  

     6.   Business in South Carolina suspended or entirely discontinued without successor.  

     7.   Business in South Carolina acquired by successor.  

  If you checked 5 through 7, please explain below: 
   
  I CERTIFY THAT THE INFORMATION ENTERED ON THIS FORM IS TRUE AND ACCURATE, AND THAT I AM AUTHORIZED BY THE NAMED 
  EMPLOYING UNIT TO COMPLETE THIS REPORT. (In order for this form to be processed, the signatory must be on file with DEW as a business owner, 
  officer, partner or agent duly authorized to act on behalf of this employer.) 
   
  Name (Print )__________________________________________________________  Title ________________________________________________________ 
   
  Signature _________________________________________________   Date ____________________   Phone No. _________________________________________ 
                                                      Please mail the completed form to: 
                                                                                 
                                                                      SCDEW 
                                                                      Document Control 
                                                                      PO Box 995 
                                                                      Columbia, SC 29202