Certification Year and Type of Certification - State of New Jersey 2026

1. Click ‘Get Form’ to open the Certification Year and Type of Certification form in the editor.
2. In Part 1, select the appropriate certification year by checking the box next to '2009' or 'Other'. If you choose 'Other', specify the year in the provided space. Remember, a separate form is required for each certification year.
3. Indicate the type of certification by checking one of the options: Initial, Annual, or Supplemental. Ensure you understand which category applies to your situation.
4. Proceed to Part 2 and fill in your Manufacturer Identification details including Company Name, Mailing Address, City, State, Zip Code, Phone Number, Country, Fax Number, FEIN, Name and Title of Person Completing this Form, and Email Address.
5. In Part 3, check whether your company is registered to do business in New Jersey. If yes, attach the necessary certification; if not, appoint an agent for service of process as outlined.
6. Complete Part 4 by providing details about the appointed agent including their contact name, physical address, phone number, email address and availability hours.
7. Finally, in Part 5 ensure that an authorized designee signs and dates the document. This signature must be notarized before submission.

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