Application for Employer Identification Number
Form
(Rev. December 2019)
SS-4 (For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, Indian tribal entities, certain individuals, and others.)
EIN
OMB No. 1545-0003
▶ Go to www.irs.gov/FormSS4 for instructions and the latest information.
Department of the Treasury
Internal Revenue Service ▶ See separate instructions for each line. ▶ Keep a copy for your records.
1 Legal name of entity (or individual) for whom the EIN is being requested
Type or print clearly.
Lazerpay, Inc.
2 Trade name of business (if different from name on line 1) 3 Executor, administrator, trustee, “care of” name
4a Mailing address (room, apt., suite no. and street, or P.O. box) 5a Street address (if different) (Don’t enter a P.O. box.)
Astrolabs, Cluster R JLT
4b City, state, and ZIP code (if foreign, see instructions) 5b City, state, and ZIP code (if foreign, see instructions)
, Dubai, AE
6 County and state where principal business is located
New Castle, Delaware
7a Name of responsible party 7b SSN, ITIN, or EIN
Njoku Emmanuel Foreign
8a Is this application for a limited liability company (LLC) 8b If 8a is “Yes,” enter the number of
(or a foreign equivalent)? . . . . . . . . ☐ Yes ☒ No LLC members . . . . . .
8c If 8a is “Yes,” was the LLC organized in the United States? . . . . . . . . . . . . . . . . . ☐ Yes ☐ No
9a Type of entity (check only one box). Caution: If 8a is “Yes,” see the instructions for the correct box to check.
☐ Sole proprietor (SSN) ☐ Estate (SSN of decedent)
☐ Partnership ☐ Plan administrator (TIN)
☒ Corporation (enter form number to be filed)
☐ Trust (TIN of grantor)
☐ Personal service corporation ☐ Military/National Guard ☐ State/local government
☐ Church or church-controlled organization ☐ Farmer’s cooperative ☐ Federal government
☐ Other nonprofit organization (specify) ☐ REMIC ☐ Indian tribal governments/enterprises
☐ Other (specify) ▶ Group Exemption Number (GEN) if any
9b If a corporation, name the state or foreign country (if State Foreign country
applicable) where incorporated Delaware
10 Reason for applying (check only one box) ☐ Banking purpose (specify purpose)
☒ Started new business (specify type) _Corporation ☐ Changed type of organization (specify new type)
___________________________________________
☐ Purchased going business
☐ Hired employees (Check the box and see line 13.) ☐ Created a trust (specify type)
☐ Compliance with IRS withholding regulations ☐ Created a pension plan (specify type)
☐ Other (specify)
11 Date business started or acquired (month, day, year). See instructions. Closing month of accounting year December
12
10/10/2021
[business_started_date_field] 14
If you expect your employment tax liability to be $1,000
13 Highest number of employees expected in the next 12 months (enter -0- if or less in a full calendar year and want to file Form 944
none). If no employees expected, skip line 14. annually instead of Forms 941 quarterly, check here.
(Your employment tax liability generally will be $1,000
Agricultural Household Other or less if you expect to pay $5,000 or less in total
wages.) If you don’t check this box, you must file
Form 941 for every quarter. ☐
15 First date wages or annuities were paid (month, day, year). Note: If applicant is a withholding agent, enter date income will first be paid to
nonresident alien (month, day, year) . . . . . . . .
. . . . . . . .
16 Check one box that best describes the principal activity of your business. ☐ Health care & social assistance ☐ Wholesale-agent/broker
☐ Construction ☐ Rental & leasing ☐ Transportation & warehousing ☐ Accommodation & food service ☐ Wholesale-other ☐ Retail
☐ Real estate ☐ Manufacturing ☐ Finance & insurance ☒ Other (specify) Technology
17 Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.
Software / e-commerce / Internet business
18 Has the applicant entity shown on line 1 ever applied for and received an EIN? ☐ Yes ☒ No
If “Yes,” write previous EIN here
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Third Designee’s name Designee’s telephone number (include area code)
Party Chelsea Chapman ( 844 ) 386-0178
Designee Address and ZIP code Designee’s fax number (include area code)
10601 Clarence Drive, Suite 250, Frisco, TX, 75033 ( 469 ) 294-4510
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and Applicant’s telephone number (include area code)
complete.
Name and title (type or print clearly) Njoku Emmanuel, President
Applicant’s fax number (include area code)
Signature [signature_field] Date [signed_date_field] ( 469 ) 317-3436
10/10/2021
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 16055N Form SS-4 (Rev. 12-2019)
