Document design, form creation, and data management are all important elements of a successful business. In order to create the best possible documents and forms for your company, you need the right tools. 2746 is one such tool that can help you manage your data and create professional-looking documents. With its simple interface and wide range of features, 2746 is the perfect solution for any business owner in need of document design software. Learn more about this powerful program in our latest blog post!
| Question | Answer |
|---|---|
| Form Name | Form As 2746 |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | AS 2746 form as 2746 |
Form AS 2746 |
Commonwealth of Puerto Rico |
|
|
|
|
||
Rev. 01.06 |
DEPARTMENT OF THE TREASURY |
|
|
|
|||
Internal Revenue Area |
|
|
|
|
|||
|
|
|
|
|
|
||
|
|
CERTIFICATION FOR LISTING ON PUERTO RICO DIRECTORY |
|
|
|||
|
; Original |
; Supplemental |
|
Sales Year: _________________ |
|||
|
|
|
|
|
|
|
|
|
PART I: GENERAL BUSINESS AND OWNERSHIP INFORMATION |
|
|
|
|
||
|
1. Applicant Tobacco Product Manufacturer (“PM”) Identification |
|
|
|
|
||
|
Applicant |
|
|
Employer Identification Number |
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
||
|
Street Address |
|
|
Phone Number |
Fax Number |
||
|
|
|
|
( |
) |
( |
) |
|
|
|
|
|
|
||
|
Mailing Address (if different from above) |
|
|
Website Address |
|||
|
|
Zip Code |
|
|
|
|
|
|
Manufacturing Plant(s) Name and Street Address (if different from above) |
|
Name/Title of Person Completing Certification |
||||
|
|
|
|
|
|
|
|
2.The undersigned certifies under oath that as of the date of this Certification, the above - named applicant is (initial one):
a Participating Manufacturer (“PM”). (If applicant is a PM, it may skip the remainder of Part I and go directly to Part II.)
a Nonparticipating Manufacturer (“NPM”) in full compliance with Act No. 401 of September 9, 2000, as amended, and implementing regulations, including having made all required deposits into a Qualified Escrow Fund.
3.Applicant is the manufacturer of the brands listed in this Certification which are intended to be sold in Puerto Rico, including Cigarettes intended to be sold in Puerto Rico through an importer.
;Yes ; No
4.Applicant is the first purchaser anywhere for resale in Puerto Rico of Cigarettes manufactured anywhere that the manufacturer does not intend to be sold in Puerto Rico.
;Yes ; No
If the answer is “Yes”, identify each Cigarette manufacturer, its plant street address, mailing address, contact person, telephone and facsimile phone numbers, and the relationship to applicant. Identify the location of the transfer of ownership of Cigarettes and a copy of every agreement or contract between applicant and manufacturer. Attach additional sheet(s), as necessary, to provide a complete response.
Conservation Period: Six (6) years.
Form AS 2746, Rev. 01.06 - Page 2
5. Applicant is a successor of an entity described in questions 3 or 4 above (i.e., manufacturer or first importer).
;Yes ; No
6.If applicant answered “No” to questions 3, 4, and 5 above, explain the basis for applicant’s claim that it is a Tobacco Product Manufacturer and submit all documentation to support applicant’s contention. Attach additional sheet(s), as necessary, to provide a complete response.
PART II: BRAND FAMILY IDENTIFICATION 1. Brand Families Unit Sales Schedule
(Original Form AS 2743 Brand Families Unit Sales Schedule, must be submitted with this certification.)
2. Trademark Holder(s)
(If applicant is a PM, it may skip Question 2 and go directly to DECLARATION, ACKNOWLEDGMENT AND SIGNATURE, page 5.) Provide the name, address, and phone number of the trademark holder(s) of each brand listed above.
Brand
Trademark Holder and
Contact Person
Physical Address
Phone
Attach additional sheet(s), as necessary, to provide a complete response.
PART III: ADDITIONAL BUSINESS INFORMATION |
|
|
1. Applicant Information |
|
|
Please indicate whether the following statements describe applicant by marking either Yes or No after the statement: |
|
|
a. Applicant sold Cigarettes in Puerto Rico in the preceding calendar year |
;Yes ;No |
|
b. Applicant made escrow deposits in the preceding calendar year |
;Yes |
;No |
c. Applicant sold in the preceding calendar year one or more of the Brand Families listed in this Certification |
;Yes |
;No |
d. Applicant made escrow deposits in the preceding calendar year for one or more of the Brand Families listed in this Certification |
;Yes |
;No |
e. There has been a change in manufacturer of one or more of the Brand Families listed in this Certification within the past two calendar |
;Yes |
;No |
years |
||
f. Applicant advertises or sells Cigarettes via the internet or in catalogs and uses the mail or other delivery service to deliver Cigarettes to Puerto |
;Yes |
;No |
Rico consumers |
||
g. Applicant failed to timely comply with Act No. 401 of September 9, 2000, as amended, prior to the establishment of the Directory, or at any time |
;Yes |
;No |
thereafter |
||
Conservation Period: Six (6) years.
Form AS 2746, Rev. 01.06 - Page 3
h.Applicant or one of its Brand Families listed in this Certification was previously denied listing on the Directory or was removed from the Directory ......................................................................................................................................................................................................
i.Applicant is enjoined or banned from selling any Cigarettes by court order, state or federal agency ruling or determination ........................
j.A Brand Family formerly sold by applicant or a Brand Family that applicant intends to sell is enjoined from sale by a state court, state agency or a federal court ...............................................................................................................................................................................................
k.A state or federal court has entered a judgment finding that applicant engaged in an unfair business practice or unfair competition relating to the sale of tobacco products ........................................................................................................................................................
;Yes ;No
;Yes ;No
;Yes ;No
;Yes ;No
PART IV: NPM APPLICANT CERTIFICATION 1. Agent for Service of Process
a. |
Is applicant domiciled in Puerto Rico? |
;Yes |
;No |
b. |
Is applicant a |
;Yes |
;No |
c.Name, address and phone number of agent for service of process
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
d.If applicant answered “No” to questions “a” and “b” above, applicant must appoint a resident agent for service of process by submitting a completed
NOTICE OF APPOINTMENT OF REGISTERED AGENT AND REGISTERED AGENT’S STATEMENT.
2.Qualified Escrow
|
Applicant certifies that of the date of this Certification, applicant: |
|
|
|
|
|
|
a. Has established and continues to maintain a Qualified Escrow Fund |
|
|
|
;Yes |
;No |
|
b. Has executed a Qualified Escrow Agreement that has been reviewed and approved by Puerto..................................................................................................Rico Secretary of the Treasury and (that |
;Yes |
;No |
|||
|
governs that Qualified Escrow Fund for the Commonwealth of Puerto Rico) |
|
|
|
||
3. |
Financial Institution Information |
|
|
|
|
|
|
|
|
|
|
||
Name |
|
Authorized Escrow Agent |
Escrow Account Number |
|
||
|
|
|
|
|
|
|
Address |
Phone Number ( |
) |
Fax Number ( |
) |
|
|
|
|
|
|
|
|
|
|
|
Total Funds Held in Separate Account for Puerto Rico: |
|
|
||
|
Zip Code |
$___________________________________ |
|
|
||
4.Qualified Escrow Fund Deposit/Withdrawal History for Puerto Rico
DATE
DEPOSIT
WITHDRAWAL
BALANCE
Attach additional sheet(s), as necessary, to provide a complete response.
NOTE: This Certification will not be processed or considered until all the required documents are submitted.
Conservation Period: Six (6) years.
Form AS 2746, Rev. 01.06 - Page 4
PART V: RETURNS AND DESTRUCTIONS |
|
Applicant made returns or destructions for one or more of the Brand Families during the preceding year |
;Yes ;No |
If yes, please provide Brand Family name, quantity of units and date of destruction. |
|
Brand Family
Units
Date of Destruction
Attach support of the returns or destructions certification provided by the Puerto Rico Treasury Department.
DECLARATION, ACKNOWLEDGMENT AND SIGNATURE
Under penalty of criminal prosecution under the laws of Puerto Rico, I declare and acknowledge that:
1.I have read the instructions for this Certification for Listing on Puerto Rico Directory.
2.I understand that the Attorney General and the Secretary of the Treasury Department may require additional information and/or documentation to determine if applicant qualifies for listing on the Puerto Rico Directory.
3.Applicant will immediately notify the the Internal Revenue Area (P.O. Box 9024140, San Juan, PR,
4.This Certification must be signed by a qualified company officer or other such individual authorized to bind the applicant company. My position with the company and my actual authority to certify on behalf of applicant meets the foregoing requirements.
5.I have examined this Certification, including attachments and supporting documents and, to the best of my knowledge and belief, this Certification, including attachments and supporting documents, is true, correct, and complete.
Name of Authorized Officer: __________________________________________________________________________________
Title: ____________________________________________________________________________________________________
Telephone: ______________________________________________ Date: __________________________________________
Signature of Authorized Officer:________________________________________________________________________________
Affidavit No. _________________
Sworn and subscribed before me by __________________________________________________, of legal age, _________________________ [civil status],
_________________________________ [occupation], and resident of ______________________________, ______________________________________, personally known to
me or identified by means of ________________________________, at __________________, ___________________, this ___ day of _________________, ______.
NOTARY SEAL
This Certification must be filed with the Department of the Treasury: DEPARTMENT OF THE TREASURY INTERNAL REVENUE AREA
ATT. TOBACCO LITIGATION AND ENFORCEMENT PO BOX 9024140
SAN JUAN, PR
Conservation Period: Six (6) years.
CERTIFICATION FOR LISTING ON PUERTO RICO DIRECTORY (FORM AS 2746)
GENERAL INSTRUCTIONS
Who is required to file this Certification (Form AS 2746)?
Tobacco Product Manufacturers.
Tobacco Product Manufacturer means an entity that:
(1)manufactures cigarettes anywhere that such manufacturer intends to be sold in Puerto Rico, including cigarettes intended to be sold in Puerto Rico through an importer, distributor, retailer or similar intermediary, or
(2)is the first purchaser anywhere for resale in Puerto Rico of cigarettes manufactured anywhere that the manufacturer does not intend to be sold in Puerto Rico; or
(3)becomes a successor of an entity described in subsection (1) or (2) above.
The answers provided in this Certification, when completed must be reviewed, and signed by an officer with the authority to bind the applicant company (“Applicant”).
When is this Certification due?
Every Tobacco Product Manufacturer currently selling in Puerto Rico must file a Certification (Form AS 2746) no later than April 30, 2006. After April 30, 2006, Tobacco Product Manufacturers which intend to sell Cigarettes in Puerto Rico must file a Certification and qualify for listing on the Directory prior to any sales in Puerto Rico. Tobacco Product Manufacturers listed on the Directory must file this form on or before April 30th each year.
Supplemental Certifications: In completing a supplemental Certification, applicant must check the “Supplemental” box at the top of page one, enter only the new or modified information, then sign and date the supplemental Certification form. In circumstances in which information provided on the Certification becomes inaccurate, a supplemental Certification (Form AS 2746) must be filed within thirty (30) days after the information becomes inaccurate. A Tobacco Product Manufacturer shall file a supplemental Brand Family Unit Sales Schedule (Form AS 2743) no later than thirty (30) days prior to any change in a manufacturer for any Brand Family or any addition to or modification of its Brand Families.
Where must this Certification be filed?
This Certification must be filed with the Department of the Treasury of Puerto Rico:
Mailing Address: Department of the Treasury
Internal Revenue Area
Attn.: Tobacco Litigation and Enforcement
PO Box 9024140
San Juan, PR
Definitions:
(a)“Brand Family” means all styles of cigarettes sold under the same trademark and differentiated from one another by means of additional modifiers, including, but not limited to, “menthol”, and includes any brand name, alone or in conjunction with any other word, trademark, logo, symbol, motto, selling message, recognizable pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, a previously known brand of cigarettes.
(b)“Cigarette” means any product that contains nicotine, is intended to be burned or heated under ordinary conditions of use, and consists of or contains: (i) any roll of tobacco wrapped in paper or in any substance not containing tobacco; or (ii) tobacco, in any form, that is functional in the product, which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette; or (iii) any roll of tobacco wrapped in any substance containing tobacco, which, because of its appearance, the type of tobacco used in the filler or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette described in clause (i) of this definition. The term “cigarette” includes
(c)“Directory” means the listing of all Tobacco Product Manufacturers that have provided current and accurate certifications conforming to the requirements of Act No. 305 of September 15, 2004 and all Brand Families that are listed in such certifications.
(d)“Escrow Agent” means a federally or local chartered financial institution having no affiliation with any tobacco product manufacturer and having assets of at least one billion dollars ($1,000,000,000) with whom the
(e)“Master Settlement Agreement” means the agreement subscribed between certain cigarette manufacturers and the Government of the Commonwealth of Puerto Rico on November 23, 1998.
(f)“Nonparticipating Manufacturer”, or “NPM”, means any Tobacco Product Manufacturer that is not a Participating Manufacturer.
(g)“Participating Manufacturer” has the same meaning as in subsection II (j) of the MSA.
(h)“Person” means an individual, partnership, committee, association, corporation or any other organization or group of persons.
All attachments to this Certification must indicate to which question it corresponds.
If any section of this Certification is not applicable to your company, be sure to check the box “not applicable” where relevant.
SPECIFIC INSTRUCTIONS
PART I. GENERAL BUSINESS AND OWNERSHIP INFORMATION
Questions
PART II. BRAND FAMILY IDENTIFICATION
Original Form AS 2743, Brand Families Unit Sales Schedule, must be submitted with this certification.
Brand Families Unit Sales Schedule AS 2743: Identity by Brand Family all of the Cigarettes that the Tobacco Product Manufacturer intends to sell in Puerto Rico, whether directly or through any distributor, retailer, or similar intermediary, and seeks to have included in the Directory. Only the brands identified may be included in the Directory. A Participating Manufacturer shall list all of its Brand Families. By listing a Brand Family, the Participating Manufacturer affirms that the Brand Family is deemed to be its Cigarettes for the purpose of calculating its payments under the MSA for the relevant year. The Participating Manufacturer shall update such list at least thirty (30) days prior to any addition to or modification of its Brand Families by executing and delivering a supplemental Schedule (Form AS 2743) to the Department of the Treasury of Puerto Rico.
A Nonparticipating Manufacturer (NPM) shall: (i) List all of its Brand Families and the number of Units Sold of each Brand Family that were sold in Puerto Rico during the preceding calendar year; (ii) Identify by an asterisk any Brand Family sold in Puerto Rico during the preceding calendar year that is no longer being sold in Puerto Rico as of the date of the Certification; and (iii) Provide the complete name and address of every Tobacco Product Manufacturer that manufactured a Brand Family described in (i) above in the preceding calendar year. The NPM shall update such list at least thirty (30) days prior to any addition to or modification of its Brand Families by executing and delivering a supplemental Schedule (Form AS 2743) to the Department of the Treasury of Puerto Rico. By listing a Brand Family, the NPM affirms that the Brand Family is deemed to be its Cigarettes for the purpose of calculating its reserve fund deposits pursuant to Act. No. 401 of September 9, 2000, as amended.
PART III. ADDITIONAL BUSINESS INFORMATION
Information must be completed by Participating Manufacturers and Nonparticipating Manufacturers.
PART IV. NPM APPLICANT CERTIFICATION
Agent for Service of Process: Certify whether the NPM is (i) domiciled in Puerto Rico; (ii) a
PART V. RETURNS AND DESTRUCTIONS
Returns and Destructions: Certify (i) Brand Family Name; (ii) Units Returned or Destructed; (iii) and Date of Destruction for the preceding calendar year.
Mail the original Certification (Form AS 2746) and a complete copy of all required forms and documents to:
Mailing Address: Department of the Treasury
Internal Revenue Area
Attn.: Tobacco Litigation & Enforcement
PO Box 9024140
San Juan, PR