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Division of Unemployment Insurance
Unemployment Insurance Employer Services Clear Form Save Form
P.O. Box 8789, Denver, CO 80201-8789
EMPLOYER CHANGE REQUEST
Please type or use black ink and return to the above address. Instructions are on page 2. If you have any questions, call the telephone
number below.
PART I—EMPLOYER INFORMATION . All information in Part I must be completed by the person making the change request.
Owner, Partners, or Corporate Name Employer Account Number

Trade Name

PRIOR Street Address City State ZIP Code
INFORMATION
The form must be signed in Part IV; if this form is not signed, it cannot be processed.
PART II—CHANGE OF OWNERSHIP/TERMINATION OF BUSINESS OR EMPLOYMENT
Sole proprietorship or partnership incorporating are considered as new businesses. Change of ownership includes changing 50 percent or
more in a partnership.
NOTE: Do not complete this form if you are only transferring corporate stock.

1. Date of termination or change: _______/______/______. b. Date employer in Part I last paid wages:____/____/_____.
2. Did the employer in Part I have seasonal status with the Division? Yes No
3. Reason for change or termination:
a. Business closed e. Partial sale of business (Contact the g. Incorporation
b. No paid employees Department for information concerning h. Merger
(Include corporate officers) partial transfer of experience rate to the i. Other _____________
c. Consider workers to be contract buyer)
labor f. All employees being reported by
d. Sale of entire business (All employee leasing company or
locations) management company
Name:
Account Number:
4. a. Will the employer in Part I continue to have employees in Colorado? Yes No
b. If boxes d, e, f, g, h, or i are checked above, the new employer listed below must complete Form UITL-100, Application for
Unemployment Insurance Account and Determination of Employer Liability.
1. Name of new employer ________________________________________________________________________________
2. Trade name of new employer ___________________________________________________________________________
3. Address of new employer ______________________________________________________________________________
c. If partial sale, were any employees transferred from the employer in Part I to the new employer listed above? Yes No
NEW INFORMATION
If Yes, 1. How many employees were transferred? ___________________________
2. List the total number of employees in your entire business in each of your four pay periods preceding the date of sale. This
includes all employees in the portion sold and all employees in the portion retained.
a. First pay period: c. Third pay period:
b. Second pay period: d. Fourth pay period:
PART III—CHANGE OF NAME OR ADDRESS ONLY (Must also complete Part I with previous address)
Check the appropriate box for the change: Physical location address Mailing address for ALL premium information
Owner address and/or telephone number Mailing address for all benefits information Trade name change
New Partner(s), Corporate Name (If a corporate name change, include a copy of the Certificate of Amendment)

New Trade Name

New In Care of Name (if applicable) Telephone Number

New Street City State ZIP Code

PART IV—CERTIFICATION OF CHANGE I certify that I am authorized to make this report and the information is correct.
Signature Date
ON
Title Telephone Number
REQUIRED INFORMATI

UITL-2 (R 09/2022) 303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area) Fax: 303-318-9013 or 303-318-9206

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Division of Unemployment Insurance
Unemployment Insurance Employer Services
P.O. Box 8789, Denver, CO 80201-8789

INSTRUCTIONS FOR COMPLETING THE EMPLOYER CHANGE REQUEST

Requirements for completing the form:

1. All information in Part I must be completed.
2. Complete Part II if there is a change to the business ownership or termination of business.
3. Complete Part III if there is a change to the address or telephone number.
4. Part IV must be signed for any change to be made.

NOTE: If there are distribution points assigned for the business, complete a separate form for each distribution point account number to be
changed.

Instructions for completing this form :

PART I—EMPLOYER INFORMATION

1. Owner, partners, or corporate name–the entity (owner) name.
2. Account number—The Colorado unemployment insurance (UI) account number is required.
3. Trade name—The name the business is “doing business as.”
4. Street address, city, state, and ZIP code—The current mailing address of the business that is on record for Colorado UI purposes.

PART II—CHANGE OF OWNERSHIP/TERMINATION OF BUSINESS OR EMPLOYMENT

1. The date the business was sold or closed.
2. Indicate if business in Part I was designated as a seasonal employer by UI Employer Services.
3. Check the appropriate box for the reason of the change or termination.
4. The date the last wages were paid to any employees by the employer in Part I.

NOTE: If a change in the interest of a partnership is less than 50 percent, there will not be an entity change, only a name change (see Part
III).
Complete for the sale of all or any part of the business, transfer of employees to an employee leasing/management company, incorporation, or
merger.
• Be sure to include the name and address of the new employer.
• If this is a partial sale of the business, list how many employees were transferred to the new employer. Be sure to include the name and address of the new
employer as well as a copy of the sales agreement or any other legal documentation regarding the transaction .
Form UITR-14, Application for Partial Transfer of Experience, must be filed within sixty (60) days after the notice of employer liability is mailed
to the successor employer. A partial transfer of experience will be made if the criteria for a segregable unit as defined by the Colorado
Employment Security Act 8-76-104 (5)(g) is met.

PART III—CHANGE OF NAME OR ADDRESS ONLY

NOTE: To make any address change, all information must be completed in Part I.

1. Mark the appropriate box or boxes to change the mailing address for UI information and/or UI benefits information. The address change
cannot be made without this information.
2. New, partner(s), or corporate name change—If a partnership, print the names of all partners of the business, not just the changes. If a
corporate name change, be sure to include a copy of the Certificate of Amendment from the Secretary of State.
3. Complete if there is a change, addition, or deletion of trade name.
4. Address—Include the complete address and telephone number for the owner and business, not just the change.

PART IV—CERTIFICATION OF CHANGE

1. Signature—The signature of the person requesting the change to the UI account.
2. Title—The title of the person requesting the change to the account (e.g., owner, corporate secretary, or employer representative).
3. Phone—The phone number to call if any additional information is required.
4. Date—The date the form is completed.
UITL-2 (R 09/2022) 303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area) Fax: 303-318-9013 or 303-318-9206

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