POWER OF ATTORNEY 
 
THAT:   
       Employer Name 
 
                                                            a corporation, sole proprietorship, partnership, LLC, LLP, trust  
       Account #                            FEIN # 
                                                                                         (circle one) 
       with address:       
        
does hereby constitute and appoint                                                                                         at 
 
it’s true and lawful attorney in fact with full power and authority to represent the said business entity before the: 
                                                              
                                     Delaware Division of Unemployment Insurance 
                                                              
until further notice in the following matters, to wit: 
    ☐  The presenting of completed forms, including claims for refund or adjustment of account, employer’s protest of benefit claims,                                                     
    and information relative hereto. 
    ☐  The payment of contributions. 
    ☐  The obtaining of such information as is permissible. 
    ☐  All matters affecting merit rating. 
    ☐  Participates in SIDES. 
    ☐  Access to file reports electronically. 
    ☐  Change of the official mailing address to: 
       
    ☐ The personal discussion of any or all of the foregoing with proper officials of: 
     
                                     Delaware Division of Unemployment Insurance 
 
THIS AUTHORIZATION CANCELS AND SUPERSEDES ALL PRIOR POWERS OF ATTORNEY.  THIS POWER OF ATTORNEY 
CAN BE CANCELLED BY THE BUSINESS ENTITY AT ANY TIME BY WRITTEN NOTICE TO THE DIVISION OF UNEMPLOYMENT 
INSURANCE.  
 
AFFIDAVIT: 
 
I,                                                    (Name of Authorized Citizen),  being duly sworn depose and say that I hold the office 
                                  , in the                                     , Employer Registration Number                  having 
its principal office at                                                        and am fully authorized on behalf of such company 
to grant the powers stated in said Power of Attorney to                                      (Party Granted Power of Attorney) as the 
true and lawful attorney in fact with power and authority to represent                                          (business entity) 
before the DELAWARE DIVISION OF UNEMPLOYMENT INSURANCE without first obtaining the direction and approval of the Board 
of Directors of                                        (business entity).               
                                                                            
                                                                                         (Signature of Authorized Officer) 
 
Sworn and subscribed before me this ______________ day of _______________________, 20__________. 
 
                                                                                                      Notary Public 
 (NOTARY SEAL)                                                                          Notary Expiration: