Form 5307 - Application For Determination For Adopters Of Master Or Prototype Or Volume Submitter Plans Form - Internal Revenue Service

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FILLABLE FIELD DATA SHOULD PRINT BLACK, NOT BLUE
Application for Determination for
5307
Form
Adopters of Master or Prototype or
OMB No. 1545-0202
(Rev. March 2008)
Volume Submitter Plans
Department of the Treasury
Internal Revenue Service
(Under sections 401(a) and 501(a) of the Internal Revenue Code)
For IRS Use Only
Review the Procedural Requirements Checklist before submitting this application.
1a
Number Assigned under Section 6.19
-
of Revenue Procedure 2007-6
1b Name of plan sponsor (employer if single-employer plan)
1c
Address of plan sponsor (if a P.O. Box, see instructions)
1d City
1e State
1f Zip Code
1g Country
1k Employer’s tax
1h Employer identification number
1i Telephone number
1j Fax number
year end (MM)
2a Person to contact if more information is needed. (See instructions)
(If a Power of Attorney is attached, check box and do not complete this line.)
Contact person’s name
2b Contact person’s address
2c City
2d State
2e Zip Code
2f Telephone number
2g Fax number
If more space is needed for any item, attach additional sheets the same size as this form. Identify each additional sheet with the
plan sponsor’s name and EIN and identify each item.
Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and
to the best of my knowledge and belief, it is true, correct, and complete.
SIGN HERE
Date
Type or print name
Type or print title
5307
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 11832Y
Form
(Rev. 3-2008)
*11832Y03200801*

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