Form 5316 - Application For Group Or Pooled Trust Ruling
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65316
Application for Group or
Form
Pooled Trust Ruling
OMB No. 1545-2166
(June 2011)
Department of the Treasury
(Under section 401(a) and 501(a) of the Internal Revenue Code)
Internal Revenue Service
Review the Procedural Requirements Checklist on page 3 before submitting this
For Internal Use Only
application.
1a Name of the trust sponsor
1b
1c City
1d State
1e Zip Code
Address of trust sponsor (if a P.O. Box, see instructions)
1f Country
1g Trust sponsor's employer identification number (EIN)
1h Telephone number
1i Fax number
2a Person to contact if more information is needed, see instructions
(If a Power of Attorney is attached, check box and do not complete this line.)
Contact person’s name
2b Contact person’s address
2c City
2d State
2e Zip Code
2f Telephone number
2g Fax number
If more space is needed for any item, attach additional sheets the same size as this form. Identify each additional sheet with the trust
sponsor’s name and EIN and identify each item.
3a Name of trust (If trust name exceeds 70 characters, including spaces, see instructions)
3b Enter date trust agreement was executed
Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and to
the best of my knowledge and belief, it is true, correct, and complete.
SIGN HERE
Date
▶
▶
Type or print name
Type or print title
5316
For Paperwork Reduction Act Notice, see instructions.
Form
(6-2011)
Cat. No. 49983G
49983G06201101
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Parent category: Financial