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Get CA DE 1378N 2013-2021

Artment Use Only Account No. Statistical Code Effective Date Approved By Date Employer Notified (Date) Send Number of Employees IMPORTANT This form is not an application for an account number under the compulsory provisions of the California Unemployment Insurance Code (CUIC). Do not complete this form unless you wish to apply for State Disability Insurance coverage ONLY for your employees under Section 702.6, 710.4, 710.5, 710.6, or 710.9 of the CUIC. Coverage under these sections of the CUIC.

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