Form 5307 - Application For Determination For Adopters Of Master Or Prototype Or Volume Submitter Plans Page 7

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7
Form 5307 (Rev. 3-2008)
Page
Determination request regarding the nondiscrimination design-based safe harbors of section 401(a)(4). See instructions
Yes
No
Is this a request for a determination regarding a design-based safe harbor under section 401(a)(4)?
12
Design-based nondiscrimination safe harbors:
Does the plan provide for disparity in contributions or benefits that is intended to meet the permitted disparity
a
requirements of section 401(l)? If “Yes,” answer line 12b. Otherwise, skip to line 12c.
b
Do the provisions of the plan ensure that the overall permitted limits will not be exceeded?
c
Enter the letter (“A” - “G”) from the list below that identifies the safe harbor intended to be satisfied.
A = 1.401(a)(4)-2(b)(2) defined contribution (DC) plan with uniform allocation formula
B = 1.401(a)(4)-3(b)(3) unit credit defined benefit (DB) plan
C = 1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit DB fractional rule plan
D = 1.401(a)(4)-3(b)(4)(i)(C)(2) flat benefit DB plan
E = 1.401(a)(4)-3(b)(5) insurance contract plan
F = 1.401(a)(4)-8(b)(3) target benefit plan
G = 1.401(a)(4)-8(c)(3)(iii)(b) cash balance plan
d
List the plan section(s) that satisfy the safe harbor (including, if applicable, the permitted disparity requirements)
5307
Form
(Rev. 3-2008)
*11832Y03200807*

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