E N ORT H E

DIVISION OF REVENUE AND TAXATION

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Business License Application Requirements

T N
OF M
F I
F I C I A L S E AL E N
T O F

SOLE
PROPRIETOR CORPORATION PARTNERSHIP LLC NON-PROFIT
New Renewal New Renewal New Renewal New Renewal New Renewal
License Application X X X X X X X X X X
Worker’s Compensation X X X X X X X X X X
Application
IN A-Status (Non-US) X X X X X X X X X X
Annual Corporate Report X X X X
Articles & By-Laws
(Corporation) X X
Partnership Agreement
& Registration X
LLC
Certificates of Organization X
Articles of Organization
Sketch of Business X X
Location X X X X X X X X
Original Business
License X X X X X

Note: Any box marked with an “X” indicates a required document that must be submitted with the application.
In addition, applicants must provide a copy of their passport.

SCHEDULE OF FEES:

Banks $ 500.00 Manufacturers $ 50.00

Offshore Banking 1,000.00 Wholesalers 50.00
Security Dealers 300.00

Scuba Diving Instruction $ 100.00

Insurance: Scuba Diving Tour Operation 100.00
Company $ 300.00
Broker 100.00
Agent 75.00 General Business (per activity) $ 50.00

Roadside Vendors $ 5.00

Public Utilities $ 300.00 (Selling Local Agricultural & Fishery Products ONLY )

Form: BUSLIC Page 1 Note: This revision is effective November 2015

 E N ORT H E

DIVISION OF REVENUE AND TAXATION

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Application for Business License

T N
OF M F I
F I C I A L S E AL E N
T O F

A. TYPE OF APPLICATION
TAXPAYER'S I.D. NO.:
NEW FEDERAL EMPLOYER I.D. NO. (FEIN):
RENEWAL - BUSINESS LICENSE NO.: FIRST YEAR OF OPERATION:

AMENDMENT (Check below)

Additional location Additional line(s) of business (please specify below) Change of location

Request for duplicate license(s) Add D.B.A. Change of business name

B. APPLICANT INFORMATION
1. Form of business and name of applicant
Sole Proprietorship
Partnership
Corporation
(check if foreign corporation)
LLC
Joint Venture
Other (please specify)

2. Mailing address:
Telephone: ( ) Fax: ( )
3. Email address:

C. LINE(S) OF BUSINESS APPLIED FOR (list every activity location separately)

Line of Business DBA (assumed name) Island Village Lot No.

2
3
4

If the applicant is a foreign corporation or a Non-CNMI resident, please specify the name of the registered/resident agent below.
Name:
Mailing address:
Telephone No.:

D. APPLICANT DECLARATION
I declare under penalty of perjury that the information above are true and correct and that I have complied with all CNMI laws
and regulations for purposes of obtaining a business license. This declaration is made on this day of
at

Print applicant's name Signature Title Date

OFFICIAL USE ONLY

The applicant is is not recommended for approval for the issuance of a business license. Reviewed by: Date:

Approved by: License No.

License fee paid: $ Date paid:

Original: Business License Office Yellow: Workers Compensation Office Pink: Applicant

Form: BUSLIC Page 2 Note: This revision is effective November 2015

 E N ORT H E

DIVISION OF REVENUE AND TAXATION

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NM
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Business License Application Business Location

T N
OF M
F I
F I C I A L S E AL E N
T O F

Map of Business Location

(i.e., street name, village, etc...)

Physical Location of Business

Form: BUSLIC Page 3 Note: This revision is effective November 2015

 Department of Commerce
WORKERS’ COMPENSATION COMMISSION
COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS
P.O. Box 5795 CHRB, Saipan MP 96950
Tel: (670) 664-8018/8024 • Fax (670) 664-8074
Website: www.commerce.gov.mp

Application for Certificate of Clearance

Please take notice that pursuant to the CNMI Workers' Compensation Law, as amended, every employer in the
Commonwealth is required to secure insurance coverage for employee(s) in case of occupational injury, illness, or
death. The law further requires that all applicants for business licenses in the CNMI (whether its an application for
a new business or the renewal for an existing business) must obtain a Certificate of Clearance from the Workers'
Compensation Commission before the Secretary of Finance will issue such business license.

Name of Business:

Address:
.
Name of Applicant/Representative:

PLEASE MARK THE APPROPRIATE AREA(S) BELOW

A. BUSINESS LICENSE APPLICANT - NEW:

() I am not an employer now. I do, however, understand the requirement of the Workers'
Compensation Law. If I hire any employee in the future, I will comply with the
requirements as mandated by law, and immediately secure coverage for my employee(s)
and will file a Certificate of Compliance within 30 days thereafter.

() I am an employer or will be hiring personnel within a few days. I am providing a copy of

the workers' compensation insurance policy in effect and a Certificate of Compliance
(FORM WCC- I 00) as required.

() I have never been an employer operating under a different name.

B. BUSINESS LICENSE APPLICANT - RENEWAL:

() I have renewed the workers' compensation insurance coverage. I am providing a copy of

the workers' compensation insurance policy in effect and a Certificate of Compliance
(FORM WCC-100) as required.

() I did not or no longer have any personnel employed by the business.

Signature of Applicant or Representative Date

Saipan Branch: 664-8024 Tinian Branch: 433- 0853 Rota Branch: 532-94 78
FORM WCC-101 (REV 6/96)
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