Appendix F - Streamlined Vcp Submission - Internal Revenue Service

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APPENDIX F
STREAMLINED VCP SUBMISSION
Plan Name: _____________________________________________
EIN: _______________
Plan #: _____
(Please include the plan name, EIN, and plan number information on each page of the submission.)
PART I. PLAN INFORMATION
1. APPLICANT’S NAME _______________________________________________________________________
2. APPLICANT’S ADDRESS
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. APPLICANT’S TELEPHONE NO. __________________ 4. FAX NO. ________________________________
(optional)
(optional)
5. APPLICANT’S EIN ________________________ 6. PLAN NO. ______________
7. PLAN NAME _______________________________________________________________________________
8. TYPE OF SUBMISSION
REGULAR SUBMISSION
REGULAR SUBMISSION – ANONYMOUS
REGULAR SUBMISSION – MULTI-EMPLOYER PLAN
REGULAR SUBMISSION – MULTIPLE EMPLOYER PLAN
GROUP SUBMISSION
9. TYPE OF PLAN (CHECK ONE ONLY):
01
PROFIT SHARING
10
GOV'T. DEFINED BENEFIT - 414(d)
02
401(k)
20
GOV'T. DEFINED CONTRIB. - 414(d)
03
MONEY PURCHASE
11
SEP
04
DEFINED BENEFIT
12
SARSEP
05
ESOP
13
SIMPLE
06
TARGET BENEFIT
14
STOCK BONUS
07
403(b)
15
KSOP
09
CASH BALANCE
OTHER (specify):
10. DATE (month and day) ON WHICH PLAN YEAR ENDS___________________________________________
11. NUMBER OF PARTICIPANTS IN THE PLAN AS PROVIDED ON THE MOST RECENTLY FILED FORM
5500 SERIES (See Rev. Proc. 2008-50, section 12.07.): ________________________________________________
12. ASSETS IN THE PLAN AS PROVIDED ON THE MOST RECENTLY FILED FORM 5500 SERIES
(ROUND TO NEAREST DOLLAR): $ _____________________________________________________________
(See Rev. Proc. 2008-50, section 12.07.)

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