Power of Attorney for Representing Employer 
                   under the Illinois Unemployment Insurance Act

Fax:  217-557-1948 33 South State Street, Chicago IL  60603-2802

                                                                   UIAccount ID:

Employer:

Located at:
                   Street Address, City, State, Zip Code          Telephone Number

E-mail Address:

                                                                 Third Party Agent's FEIN
                                                                 Service Bureau's SB ID

Hereby Authorizes: 
                   Service Bureau or Third Party Agent

Located at:
                   Street Address, City, State, Zip Code          Telephone Number

E-mail Address:

 to represent the Employer before the Director in any and all matters, to act in the Employer’s stead with the same
 consequences as the Employer, and to receive any and all information requested by said Representative pertaining to the
 Employer’s liability for the payment of contributions, interest and penalties under the Illinois Unemployment Insurance Act 
 (except that I understand that notices pertaining to a Determination and Assessment or  Refund/Adjustment shall be sent to 
 the employing unit at its principal place of business or its last known place of business or residence), until such time as the 
 appointment is terminated. I understand that my Representative shall be provided information only to the extent that it is
 requested for one of the purposes set forth in Section 1900 of the Illinois Unemployment Insurance Act [820 ILCS
 405/1900].

                   Name of Employer:

                   Signature:

                   Print:

                   Title:

                   Date:

LE-10 (Rev. 2/20)

                   UNEMPLOYMENT INSURANCE SPECIAL MAILING FORM

Fax: 217-557-1948  33 SOUTH STATE STREET CHICAGO, IL 60603-2802

The purpose of this form is to notify the Department of a request to have correspondence sent to an address 
other than your business address or to terminate a preexisting address, except that notices pertaining to a 
Determination and Assessment or Refund/Adjustment shall be sent to the employing unit at its principal place 
of business or its last known place of business or residence. If the requested address being added is for a 
third party or service bureau, you must also complete the Power of Attorney (LE-10) form.

Employer Name
DBA Name
Illinois UI Account Number
Federal I.D. Number
Note: Each form can be directed to only one address. Therefore, check only once for each form. If your 
request cannot be contained in its entirety on this form because of multiple addresses, please provide 
additional copies of the form:

  BIS-32 (Notice to Chargeable Employer)
                                         C/O (Name of Representative or Service Bureau)
  UI-3/40 (Contribution & Wage Report)
  Ben-118/118R Benefit Charge Notice
                                         Street Address                                  Unit or Suite 
  UI-5A/UI5B (Rate Notice)
  Benefit Appeal Notice                  City, State, ZIP
  SI-5 (Notice of Benefit Earnings Audit)
                                         Country               Telephone Number

                                         E-Mail Address

Effective Date                           Termination Date

  BIS-32 (Notice to Chargeable Employer)
                                         C/O (Name of Representative or Service Bureau)
  UI-3/40 (Contribution & Wage Report)
  Ben-118/118R Benefit Charge Notice
                                         Street Address                                  Unit or Suite 
  UI-5A/UI5B (Rate Notice)
  Benefit Appeal Notice                  City, State, ZIP
  SI-5 (Notice of Benefit Earnings Audit)
                                         Country               Telephone Number

                                         E-Mail Address

Effective Date                           Termination Date

Signed by                                Date

Title                                    Telephone Number

UI-1M (Rev. 9/17)