Form 8925 - Report Of Employer-Owned Life Insurance Contracts Page 2
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Form 8925 (Rev. 9-2017)
Page
Who Must File
Recordkeeping
Paperwork Reduction Act
Notice
Generally, every policyholder owning
You must keep adequate records to
one or more employer-owned life
support the information reported on
We ask for the information on this form
insurance contracts issued after August
Form 8925.
to carry out the Internal Revenue laws of
17, 2006, must file Form 8925 for each
the United States. You are required to
Specific Instructions
tax year the contract(s) is owned.
give us the information. We need it to
Section 1035 exchanges.
ensure that you are complying with these
Name of Policyholder
Policyholders are not required to
laws and to allow us to figure and collect
Enter the name of the policyholder
complete Form 8925 for a life insurance
the right amount of tax.
(defined earlier).
contract issued after August 17, 2006, as
You are not required to provide the
part of a section 1035 exchange for a
Identifying Number
information requested on a form that is
contract issued before August 18, 2006.
subject to the Paperwork Reduction Act
The identifying number of an individual
See Q&A-15 in Notice 2009-48 for more
unless the form displays a valid OMB
is a social security number. For all other
information.
control number. Books or records
taxpayers, it is an employer identification
However, any material increase in the
relating to a form or its instructions must
number.
death benefit or other material change
be retained as long as their contents
Type of Business
to the contract will cause it to be treated
may become material in the
as a new contract and the policyholder is
administration of any Internal Revenue
Enter the policyholder’s trade or
required to file Form 8925. See Q&A-14
law. Generally, tax returns and return
business activity.
in Notice 2009-48 for more information.
information are confidential, as required
Line 4a
by section 6103.
For master contracts under section
264(f)(4)(E), the addition of covered lives
The time needed to complete and file
Valid consent. Before the issuance of
is treated as a new contract only for the
this form will vary depending on
the employer-owned life insurance
additional covered lives.
individual circumstances. The estimated
contract, the employee must provide
burden for individual and business
See sections 1035 and 264(f)(4)(E) and
written consent (a) to be insured under
taxpayers filing this form is approved
Notice 2009-48 for more information.
the contract and (b) that coverage may
under OMB control numbers 1545-0074
continue after the insured terminates
When To File
and 1545-0123. The estimated burden
employment.
for all other taxpayers who file this form
Attach Form 8925 to the policyholder’s
Note: The written consent is not valid
is shown below.
income tax return for each tax year
unless the related employer-owned life
during which the policyholder has
Recordkeeping .
.
.
. 2 hr., 23 min.
insurance contract is issued (see Issue
employer-owned life insurance
date of contract on page 1) within a year
Learning about the law
contract(s) in force.
after the consent was executed, or
or the form
.
.
.
.
. 1 hr., 00 min.
before the employee terminates
Preparing the form
.
.
1 hr., 4 min.
employment with the trade or business
If you have comments concerning the
of the applicable policyholder, whichever
accuracy of these time estimates or
is earlier. For additional notice and
suggestions for making this form
consent requirements that may apply,
simpler, we would be happy to hear
see item 1 under Notice and consent
from you. See the instructions for the
requirements on page 1. Also, see
tax return with which this form is filed.
Q&A-9 in Notice 2009-48 for more
information.
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