Form 8950 - Application For Voluntary Correction Program (Vcp)

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8950
Application for Voluntary
OMB No. 1545-1673
Form
Correction Program (VCP)
For IRS Use Only
(Rev. November 2017)
Under the Employee Plans Compliance Resolution System (EPCRS)
Department of the Treasury
Go to for instructions and the latest information.
Internal Revenue Service
Review the attached Procedural Requirements Checklist before mailing this VCP submission to the IRS.
1a Name of plan sponsor (employer if single-employer plan)
1b
1c City or town
1d State
1e ZIP code
Address of plan sponsor (if a P.O. box, see instructions)
1f Foreign country name
1g Foreign province/county
1h Foreign postal code
1i Employer identification number
1j Telephone number
1k Fax number
1l NAICS Business Code
2a Person to contact if more information is needed (see instructions).
(If a Power of Attorney is attached, check box and do not complete lines 2a through 2g.)
Name
2b Address
2c City or town
2d State
2e ZIP code
2f Telephone number
2g Fax number
If more space is needed for any line items, attach additional sheets of the same size as this form. Identify each additional sheet with
the plan sponsor’s name and EIN and identify the corresponding line item.
Under penalties of perjury, I declare that I have examined this VCP submission, including Form 8950 and all accompanying
documents, and, to the best of my knowledge and belief, they and the facts presented in support of this application and submission
are true, correct, and complete.
SIGN HERE
Date
This application must generally be signed by the owner of a sole proprietor or by
an officer with legal authority to bind a corporation, partnership, or organization.
For exceptions, see instructions under Who Must Sign.
Type or print title
Type or print name
8950
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 37769K
Form
(Rev. 11-2017)

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