Form 8925 - Report Of Employer-Owned Life Insurance Contracts Page 2
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Form 8925 (Rev. 1-2010)
Page
Specific Instructions
Who Must File
You are not required to provide the
information requested on a form that is
Generally, every policyholder owning
Name of Policyholder
subject to the Paperwork Reduction Act
one or more employer-owned life
unless the form displays a valid OMB
Enter the name of the policyholder
insurance contracts issued after August
control number. Books or records
(defined earlier).
17, 2006, must file Form 8925 for each
relating to a form or its instructions must
tax year the contract(s) is owned.
Identifying Number
be retained as long as their contents
Section 1035 exchanges.
may become material in the
The identifying number of an individual
Policyholders are not required to
administration of any Internal Revenue
is a social security number. For all other
complete Form 8925 for a life insurance
law. Generally, tax returns and return
taxpayers, it is an employer identification
contract issued after August 17, 2006, as
information are confidential, as required
number.
part of a section 1035 exchange for a
by section 6103.
Type of Business
contract issued before August 18, 2006.
The time needed to complete and file
See Q&A-15 in Notice 2009-48 for more
Enter the policyholder’s trade or
this form will vary depending on
information.
business activity.
individual circumstances. The estimated
However, any material increase in the
Line 4a
burden for individual taxpayers filing this
death benefit or other material change
form is approved under OMB control
Valid consent. Before the issuance of
to the contract will cause it to be treated
number 1545-0074 and is included in the
the employer-owned life insurance
as a new contract and the policyholder is
estimates shown in the instructions for
contract, the employee must provide
required to file Form 8925. See Q&A-14
their individual income tax return. The
written consent (a) to be insured under
in Notice 2009-48 for more information.
estimated burden for all other taxpayers
the contract and (b) that coverage may
who file this form is shown below.
For master contracts under section
continue after the insured terminates
264(f)(4)(E), the addition of covered lives
Recordkeeping .
.
.
2 hrs., 23 min.
employment.
is treated as a new contract only for the
Learning about the law or the
additional covered lives.
Note. The written consent is not valid
form
.
.
.
.
.
.
. 1 hr., 00 min.
unless the related employer-owned life
See sections 1035 and 264 (f)(4)(E) and
Preparing the form
.
.
1 hr., 4 min.
insurance contract is issued (see Issue
Notice 2009-48 for more information.
If you have comments concerning the
date of contract on page 1) within a year
accuracy of these time estimates or
How To File
after the consent was executed, or
suggestions for making this form
before the employee terminates
Attach Form 8925 to the policyholder’s
simpler, we would be happy to hear
employment with the trade or business
income tax return for each tax year,
from you. See the instructions for the
of the applicable policyholder, whichever
during which the policyholder has
tax return with which this form is filed.
is earlier. For additional notice and
employer-owned life insurance
consent requirements that may apply,
contract(s) in force.
see item 1 under Notice and consent
Recordkeeping
requirements on page 1. Also, see
Q&A-9 in Notice 2009-48 for more
You must keep adequate records to
information.
support the information reported on
Form 8925.
Paperwork Reduction Act Notice
We ask for the information on this form
to carry out the Internal Revenue laws of
the United States. You are required to
give us the information. We need it to
ensure that you are complying with these
laws and to allow us to figure and collect
the right amount of tax.
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