Form 5307 - Application For Determination For Adopters Of Master Or Prototype Or Volume Submitter Plans Form - Internal Revenue Service Page 2

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2
Form 5307 (Rev. 3-2008)
Page
3a
Determination requested for (enter applicable number in box)
1 - Initial Qualification
2 - Request after Initial Qualification
3 - Standardized Plans (See instructions)
b
If line 3a is 1, please enter the date the plan was signed
c
Enter number of amendments included
d
Enter the date the amendment(s) reflected in 3c were signed (If more than 4 see instructions)
(i)
(ii)
(iii)
(iv)
e
Enter the date the amendment(s) were effective (If more than 4 see instructions)
(i)
(ii)
(iii)
(iv)
Yes
No
Has the plan received a determination letter?
f
If “No,” submit copies of all prior plan(s) and/or adoption agreement(s).
g
If 3f is “Yes,” enter the date of the latest letter (See instructions)
h
Enter the number of amendments since the last determination letter
Have interested parties been given the required notification of this application? (See instructions)
i
Does the plan have a cash or deferred arrangement (section 401(k))?
j
k
Does the plan have matching contributions (section 401(m))?
Does the plan have after-tax employee voluntary contributions (section 401(m))?
l
m
Does the plan utilize the permitted disparity rules of section 401(l) when allocating contributions or benefits?
Is this plan an offset arrangement with any other plans? (If “Yes,” attach a separate statement providing
n
the name, EIN, and plan type of the other plan that is part of the arrangement. See instructions)
5307
Form
(Rev. 3-2008)
*11832Y03200802*

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