Use the FormsPal online editor to complete and download the exclusion statement without installing any software. The tool lets you type into all fields, add your signature, and save a print-ready PDF document.
Step 1: Enter employer and shareholder details
Click the "Get Form" button at the top of this page to open the online PDF editor. In the first section, enter the corporation's legal name, the EDD Employer Account Number, and your Federal Employer Identification Number. Then select the applicable statement confirming you are the sole shareholder or that only you and your spouse hold shares in the corporation. Complete all fields in this section before moving to the next part.
Step 2: Add your signature and complete the certification
In the second part of the document, review the exclusion certification text, then add the sole shareholder's signature in the space provided. If your spouse also holds shares, fill in the Sole Shareholder's Spouse section as required. Leave the FOR DEPARTMENT USE ONLY area blank. That portion is completed by EDD staff after they receive your submission.
Step 3: Download and submit to the EDD
After reviewing all entries for accuracy, click "Done" to finalize the document. Download the completed PDF and mail or deliver it to the appropriate EDD office before the quarterly filing period closes. You may also need related California payroll forms. For the employee withholding allowance form, see the DE 4 Withholding Allowance Certificate. To register a new employer account, see the DE 1 Commercial Employer Account Registration. For other California payroll resources, browse employment forms or the EDD Unemployment Insurance form.
