Form 8905 - Certification Of Intent To Adopt A Pre-Approved Plan

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8905
Certification of Intent To Adopt a Pre-approved Plan
OMB No. 1545-2011
Form
Eligibility for the six (6) year remedial amendment cycle as
For IRS Use Only
(January 2012)
described in Part IV of IRS Revenue Procedure 2007-44
Department of the Treasury
Attach to Form 5300, 5307, 5310
Internal Revenue Service
▶
Part I
Plan Sponsor Information - Enter all requested information
1a Employer name
1b Employer Identification Number (EIN)
1c Employer’s plan name
1d Plan number
1e Plan type - Enter 1 for DCP or 2 for DBP
Master and Prototype (M&P) Sponsor or Volume Submitter Practitioner Information - Enter all requested
Part II
information
2a Name of M&P sponsor or volume submitter practitioner
2b M&P sponsor or volume submitter practitioner EIN
2c Name of M&P plan or volume submitter specimen plan (see instructions)
Part III
Certifications
This certification must be signed and dated by both parties before the end of the employer’s applicable five-year remedial amendment cycle as determined under Part III of
Revenue Procedure 2007-44 (see instructions regarding who must sign).
3 Under penalties of perjury the employer identified in line 1a, certifies that it intends to adopt the plan identified in line 2c.
Signature / Title of employer
Date
4 The M&P sponsor or volume submitter practitioner, listed above, certifies that an application for an opinion or advisory
letter for the M&P plan or volume submitter specimen plan identified above was filed on or will be filed by
M M
D D
Y Y Y Y
Preparer’s signature / Title of M&P sponsor or volume submitter practitioner
Date
8905
For Paperwork Reduction Act Notice, see instructions.
Form
(1-2012)
Cat. No. 37714B
*37714B01201201*

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