Cal. Code Regs. Tit. 17, div. 3, ch. 1, subch. 10, art. 5, subart. 10, app A

Current through Register 2024 Notice Reg. No. 36, September 6, 2024
Appendix A

Entity Information

Legal Name

Operating Name

U.S. Federal Tax Employer Identification Number

Value Added Tax Identification Number

Data Universal Numbering System Number

Date of incorporation

Place of Incorporation:

Country of Incorporation

Business Number (Assigned by California Agency)

Physical Address (City, State, postal code)

Mailing Address (City, State, postal code)

Country

Contact Information (Name, address, phone, email)

Website Address

Type of Organization

First Name

Middle Name

Last Name

Personal Residence Address

Phone number

Email

Social Security Number

Date of Birth

Citizenship

Employer Name

Employer Address

Copy of a valid identity card issued by a state or province with an expiration date

Copy of a government-issued identity document

Copy of a Passport

Documentation of an open bank account

Documentation of any felony convictions during the previous five years

Cal. Code Regs. Tit. 17, div. 3, ch. 1, subch. 10, art. 5, subart. 10, app A