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. Please 
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 acquisition may be restricted.
Instructions - Please 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 for explanations, please attach separate sheets. For additional 
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, please 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: (Please check all that apply.)
          Place of business                Customers                  Trade name
          Accounts receivable              Goodwill                   Stock in trade
          Tools and fixtures               Staff of employees
12. Did you continue the operation of the business you acquired?     Yes    No
   If no, please 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, please 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, please 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 Sections II and III.

Section II: 
1. The portion of the business acquired was started by its previous owner on:                 (date)
2. The portion of the business acquired is  % of the previous owner’s business. 
3. If possible, please 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:  2019  $                             2020  $               2021  $

                                                   - By Quarters -
            Jan. 1 to Mar. 31      Apr. 1 to Jun. 30           Jul. 1 to Sept. 30                 Oct. 1 to Dec. 31
    2022  $                        $                           $                                  $
    202  3$                        $                           $                                  $

    If you cannot provide exact figures, please give us your estimate. To obtain the most accurate estimate, 
    please 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:
    Please 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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