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                             Certification of Intent To Adopt a Pre-approved Plan                                   OMB No. 1545-2011
Form  8905                        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.
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    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
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    Preparer’s signature / Title of M&P sponsor or volume submitter practitioner                             Date
For Paperwork Reduction Act Notice, see instructions.                         Cat. No. 37714B                       Form 8905 (1-2012)



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Form 8905 (1-2012)                                                                                                             Page 2

General Instructions                             Line 1b – Employer Identification          Line 4. Enter the date by which the 
                                                 Number (EIN). Enter the 9-digit EIN        opinion or advisory letter application for 
Purpose of Form                                  assigned to the plan sponsor/employer.     the M&P plan or volume submitter 
Use Form 8905 to treat an employer as                      Do not use a social security     specimen plan being adopted by the 
                                                                                            employer was or must be submitted as 
eligible for the 6-year remedial                           number or the EIN of the trust.  determined under Part IV of Rev. Proc. 
amendment cycle under Part IV of Rev.            !                                         2007-44.
                                                 CAUTION
Proc. 2007-44, 2007-28 I.R.B. 54.
                                                 Line 1c – Employer’s plan name. Enter 
Who May File                                     the name of the employer’s plan which      Paperwork Reduction Act Notice. We 
                                                 will be amended or restated by the         ask for the information on this form to 
An adopter of an individually designed           adoption of a pre-approved plan.           carry out the Internal Revenue laws of 
plan or pre-approved plan (not otherwise 
entitled to the 6-year remedial                  Line 1e – Plan Type.                       the United States. You are required to 
                                                                                            give us the information. We need it to 
amendment cycle) files this form when            • Enter “1” for a defined contribution     ensure that you are complying with these 
necessary to request that their 5-year           plan (DCP).                                laws and to allow us to figure and collect 
remedial amendment cycle be converted 
to the  6-year remedial amendment cycle          • Enter “2” for a defined benefit plan     the right amount of tax.
(as described under Parts III and IV of          (DBP).                                     You are not required to provide the 
Rev. Proc. 2007-44).                                                                        information requested on a form that is 
                                                 Part II – M&P Sponsor or                   subject to the Paperwork Reduction Act 
When To Complete                                 Volume Submitter                           unless the form displays a valid OMB 
Complete Form 8905 before the end of             Practitioner                               control number. Books or records 
                                                                                            relating to a form or its instructions must 
the employer’s 5-year remedial                   Line 2a – Name of M&P sponsor or           be retained as long as their contents 
amendment cycle as determined under              volume submitter practitioner. Enter       may become material in the 
Part III of Rev. Proc. 2007-44.                  the name of the M&P sponsor or volume      administration of any Internal Revenue 
                                                 submitter practitioner whose plan you      law. Generally, tax returns and return 
How To File                                      will be adopting.                          information are confidential, as required 
File the completed Form 8905 by                  Line 2b – M&P sponsor or volume            by Internal Revenue Code section 6103.
attaching it to one of the following             submitter practitioner EIN. Enter the 9-   The time needed to complete and file 
applications.                                    digit EIN assigned to the M&P sponsor      this form will vary depending on 
• Form 5300, Application for                     or volume submitter practitioner.          individual circumstances. The estimated 
Determination for Employee Benefit Plan          Line 2c – Name of the M&P plan or          average time is:
• Form 5307, Application for                     volume submitter specimen plan.            Recordkeeping   .   . .   3 hr., 21 mins.
Determination for Adopters of Master or          Enter the name of the M&P plan or 
Prototype or Volume Submitter Plans              volume submitter specimen plan the         Learning about the law 
• Form 5310, Application for                     employer intends to adopt.                 or the form .   .   . .  .  .    12 mins.
Determination for Terminating Plan                 Example. Volume Submitter Profit         Preparing, copying, 
                                                 Sharing Plan.                              assembling, and sending 
            If no Form 5300, 5307, or 5310                                                  the form to the IRS   .  .  .    15 mins.
            filing is made, the employer         Part III – Certifications                  If you have comments concerning the 
!          should keep the original                                                        accuracy of these time estimates or 
CAUTION     certification in their records       The employer and the M&P sponsor or 
and should not file Form 8905 with the           volume submitter practitioner must sign    suggestions for making this form 
IRS.                                             and date this certification before the end simpler, we would be happy to hear from 
                                                 of the employer’s applicable 5-year        you. You can write to the Internal 
Filing a Complete                                remedial amendment cycle as                Revenue Service, Tax Products 
                                                 determined under Part III, of Rev. Proc.   Coordinating Committee, 
Certification                                    2007-44. The employer must manually        SE:W:CAR:MP:M:T:S, 1111 Constitution 
Certifications are screened for                  sign the form. Scanned or stamped          Ave., NW, IR-6526, Washington, DC 
completeness. The certification must be          signatures will not be accepted. The       20224. Do not send Form 8905 to this 
signed and dated by the employer and             M&P sponsor and the volume submitter       address; instead, see the instructions for 
the pre-approved plan sponsor or                 practitioner may use a stamped,            the application with which this form is 
practitioner.                                    scanned, or electronic signature.          filed.
            You must retain a complete 
            certification until it is filed with 
!          the appropriate application.
CAUTION

Specific Instructions
Part I – Plan Sponsor 
Information
Line 1a – Employer name. Enter the 
company (employer’s) complete name.






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