California Tobacco Directory Forms

Forms For Participating Manufacturers (PMs) and Non-Participating Manufacturers (NPMs)

All manufacturers and all importers shall obtain and maintain a license from the Board of Equalization in order to engage in the sale of cigarettes and roll-your-own tobacco in California (Bus. & Prof. Code, § 22979, subd. (a).) In order to be eligible for licensure all manufacturers and all importers must waive sovereign immunity or post a surety bond in a form and manner acceptable to the Attorney General (Id., subd. (a)(4).)

• JUS-TOB1, pdf, Instructions, pdf
  Certification for Listing on California Directory
  All Participating and Non-Participating Manufacturers and Non-Participating Manufacturers must use this certification form (JUS-TOB1) to list any brands and brand families for sale or distribution in California.
• JUS-TOB9, pdf
  Waiver of Tribal Sovereign Immunity by Native American Tribe
  All manufacturers and importers owned by, chartered by, operated for the benefit of, and/or an "arm" of a Native American Tribe shall complete form JUS-TOB9.
• JUS-TOB10, pdf
  Waiver of Sovereign Immunity by Government-Owned Tobacco Company
  All manufacturers and all importers that are directly owned, in whole or majority part, by a state, federal or any other foreign or domestic governmental organization shall complete form JUS-TOB10.
• JUS-TOB11, pdf
  Standard Waiver of Sovereign Immunity by Tobacco Manufacturer or Importer
  All other manufacturers and all other importers not described in forms JUS-TOB 9 or JUS-TOB10 shall complete form JUS-TOB11.
• JUS-TOB14, pdf
  California Tobacco Manufacturer and Importer Surety Bond
  Certain manufacturers and importers must post a surety bond by using form JUS-TOB14. The surety bond form must be signed by an attorney-in-fact or a representative of the bonding company.
• JUS-TOB15, pdf
  Cigarette Brand Style Authentication Information
  All manufacturers must complete the Cigarette Brand Authentication Information form (JUS-TOB15) and submit electronic samples on CD or DVD of all packaging and labeling for each brand and style.

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Additional Forms For Non-Participating Manufacturers (NPMs)

• JUS-TOB2, pdf
  Notice of Appointment of Registered Agent and Registered Agent’s Statement For
  Non-Participating Manufacturer
  Non-Participating Manufacturers that are not registered to do business in California must appoint and engage continuously a California registered agent to receive service of process on behalf of the manufacturer. The Non-Participating Manufacturer must file proof of the appointment and availability of the agent to the Attorney General with its certification for listing on the Tobacco Directory.
• JUS-TOB3, pdf, Instructions, pdf
  Certification of Compliance and Affidavit Regarding Deposit of Reserve Funds into Escrow
  Non-Participating Manufacturers must submit form JUS-TOB3 with their certification for listing on the California Tobacco Directory. This form generally must be filed no later than April 30 of the year following the sales year, although certain NPMs will be required by the Attorney General to file quarterly or monthly certifications of compliance.
• JUS-TOB4, pdf
  Brand Families Unit Sales Schedule 1
  Non-Participating Manufacturers must file form JUS-TOB4 with each filing of the Certification of Compliance (form JUS-TOB3).
• JUS-TOB5, pdf, Instructions, pdf
  Acknowledgment of Receipt & Review of NPM Statute, Implementing Regulations, Forms, Calculation Method & Reporting Responsibilities for Depositing Reserve Funds
  Non-Participating Manufacturers not currently listed on the California Tobacco Directory must file form JUS-TOB5 acknowledging that the Non-Participating Manufacturer has received and reviewed Health & Safety Code sections 104555-104557 and implementing regulations. This form must be filed by a Non-Participating Manufacturer during its first quarter of sales in California and until its first Certification of Compliance (JUS-TOB3) is filed. The form must be filed with the Attorney General within 30 days of its receipt and provided to all wholesalers or distributors before the Non-Participating Manufacturer sells or ships its product to the wholesalers or distributors until the initial filing of the Certification of Compliance (JUS-TOB3).
• JUS-TOB6, pdf
  Model Escrow Agreement
  Non-Participating Manufacturers must use the California Model Escrow Agreement (form JUS-TOB6) to establish a Qualified Escrow Fund. Non-Participating Manufacturers must use the most recently revised escrow agreement that is posted on this website. (Currently 09/2010)
• JUS-TOB12, pdf
  United States Importer Declaration Accepting Joint And Several Liability
  Non-Participating Manufacturers located outside of the United States must submit a notarized form (JUS-TOB12) completed and signed by each of its U.S. importers that will sell the manufacturer’s cigarettes and tobacco products in California.
• JUS-TOB13, pdf
  Notice Of Appointment Of Registered Agent And Registered Agent’s Statement Form For Importer
  Non-Participating Manufacturers located outside of the United States must submit a notarized form (JUS-TOB13) appointing and engaging continuously a California registered agent to receive service of process for each of its U.S. importers that will sell the manufacturer’s cigarettes and tobacco products in California.

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Forms For Distributors

• JUS-TOB7, pdf
  Distributor Electronic Mail Registration
  Distributors of cigarettes and roll-your-own cigarettes must provide the Attorney General with email addresses for the purpose of receiving notifications regarding the California Tobacco Directory.

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