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A UC Account No. FEIN - - Part A: Benefits Address Confirmation Employer address (Street) (City) (Contact) (Phone) (State) (Fax) (Zip Code) (Email) EXCEPT AS PROVIDED IN PART B BELOW, THE DEPARTMENT WILL SEND ALL CORRESPONDENCE FROM THE OFFICE OF UC BENEFITS POLICY AND THE OFFICE OF UC SERVICE CENTERS REGARDING UC BENEFITS TO THE ABOVE ADDRESS. Part B: Power of Attorney , do hereby make, Know all men by these present that I, (Employer name) , whose address is constitute and ap.

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