Employment Development Department, MIC 4
                                                                      PO Box 826880 Sacramento, CA 94280-0001
                                                                      Fax applications to 1-916-319-1831
                                                                      File electronically at e-Services for Business 
                                                                      (edd.ca.gov/e-Services_for_Business)
                                                                      Do not mail with any other form.
Application for Transfer of Reserve Account
If you acquired a business from an employer who was registered with the Employment Development Department, you 
may apply for a transfer of all or a part of the reserve account. A reserve account is used to determine the Unemployment 
Insurance tax rate. Not all reserve account balances are desirable. If the transfer of your predecessor’s reserve account is 
approved, you will be subject to all or a percentage of the predecessor’s benefit charges, which could increase your rate. 
Some reserve account transfers are required per section 1061 of the California Unemployment Insurance Code (CUIC). 
Use this form to report the percent of business and employees that were transferred. Note: Any application for transfer 
filed after 90 days of the business purchase may be restricted per section 1053 of the CUIC.
Instructions - Read this form carefully and answer all questions. Failure to answer all questions may result in a delay or 
denial of your application. If you need more space to complete your answers, you can attach separate sheets. For more 
information, call the Taxpayer Assistance Center at 1-888-745-3886.

Section I:
1.  Your eight-digit employer payroll tax account number: 
2.  Your full name: 
3.  Your business name: 
4.  Business address: 
5. Name of business acquired: 
6.  Previous owner’s eight-digit employer payroll tax account number: 
7.  Previous owner’s full name: 
8.  Previous owner’s business location: 

   8a. Previous owner’s phone number: ( )  
9.  Date of acquisition: 
10.  Type of acquisition (Check one)
     Purchase. Agreed upon purchase price: $                        
     Stock purchase.
     Change in form only. If you checked this box, call the Taxpayer Assistance Center at 1-888-745-3886 before 
          submitting the application to determine if you were required to obtain a new employer payroll tax account 
          number. For example, a new employer payroll tax account number is not required if there was just a name 
          change, change from sole proprietor to corporation or partnership, partner added or deleted, new federal 
          employer identification number obtained, but same owner, LLC added, etc.
     Other. Explain:
 
11.  Major assets acquired (Check all that apply.)
     Place of business                    Customers                      Trade name
     Accounts receivable                  Goodwill                       Stock in trade
     Tools and fixtures                   Employees
12.  Did you continue the operation of the business you acquired?      Yes    No
   If No, explain: 

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13. Is there common ownership, management, or control of the business at the time of transfer?    Yes   No
14. Number of workers employed by previous owner just before sale:
15. Number of previous owner’s workers now employed by you:
16. Are you a labor contractor, employment agency, or other provider of employment services?    Yes    No
If Yes, explain operation:

17. Did you purchase an employment agency?   Yes   No  If Yes, explain operation:

18. Portion of the business acquired from the previous owner:
(a)         All of the business. If you checked this section, you are requesting a complete reserve account
            transfer which cannot be processed unless the previous owner’s employer payroll tax account number
            is inactive. If possible, provide a letter from the previous owner to deactivate their account at the date of
            acquisition. Go directly to Section III.
(b)         Part of the business. If you checked this section, complete Section II and Section III.

Section II: 
1. The portion of the business acquired was started by its previous owner on:               (MM/DD/YYYY)
2. The portion of the business acquired is           % of the previous owner’s business. 
3. If possible, provide the taxable wages for the portion of the business you acquired up to the quarter of acquisition.
Use only wages up to the $7,000 annual limit for each employee for calendar years listed below. The taxable
wages, for the portion of the previous owner’s business acquired, were:
For calendar year:  2020  $                          2021  $                       2022  $

                                                     - By Quarters -
            Jan. 1 to Mar. 31      Apr. 1 to Jun. 30            Jul. 1 to Sept. 30         Oct. 1 to Dec. 31
2023  $                            $                            $                          $
2024  $                            $                            $                          $

Note: If you cannot provide exact figures, give an estimate. To get the most accurate estimate, contact the 
previous owner for the taxable wage information.
Did you estimate these figures?       Yes     No
Did the previous owner approve these figures?         Yes     No

Section III:
List the contact person’s name and phone number:
Print Name:                                                                     Phone:  (          )  

Sign and date: I/we hereby submit this application for transfer of reserve account and declare that the above 
information is correct to the best of our knowledge and belief.

Signature:                                                                       Date:  
            (Owner, Corporate Officer, Partner, LLC Manager/Member, or authorized Agent)
Print Name:                                                                      Phone:  (         )  

Title: 

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