Application for Approval of Prototype or Employer  
Form  5306 
                            Sponsored Individual Retirement Arrangement (IRA) 
(Rev. August 2013)                                                                                                               OMB No. 1545-0390 
Department of the Treasury    (Under section 408(a), (b), (c), or (p) or section 408A of the Internal Revenue Code) 
Internal Revenue Service      ▶ Information about Form 5306 and its instructions is at www.irs.gov/form5306.
                                                                                                               For IRS Use Only 

1     Enter amount of user fee submitted (see Specific Instructions) ▶             $                           File folder number
Part I    Identifying Information (see instructions before completing this part) 
2     Approval requested for: 
a     Type of individual retirement arrangement— 
      (1)   Prototype traditional IRA under section 408(a) or 408(b)                        (2)     Prototype Roth IRA under section 408A 
      (3)   Prototype dual-purpose IRA                                                      (4)     Prototype SIMPLE IRA under section 408(p) 
      (5)   Roth or traditional IRA established by employer or 
            employee association under section 408(c)
b         Initial application 
c         Amendment—Enter ▶             (1)  Latest letter serial number               (2)  Date letter issued        (3)  File folder number 

3a    Name of applicant                                                                                         3b  Employer identification  
                                                                                                                      number of applicant 

      Number, street, and room or suite no. (If a P.O. box, see instructions.) 

      City or town, state, and ZIP code 

4a    Name of person to be contacted                                                                            4b  Telephone number 

4 c   Email address 
                                                                                   4d  If a power of attorney is attached, check box  . . . . . ▶
5 a   Type of sponsoring organization (if you are applying for a ruling under section 408(c), do not complete this item): 
      (1)   Insurance company                                                      (5)      Regulated investment company 
      (2)   Trade or professional association                                      (6)      Federally insured credit union 
      (3)   Savings and loan association that qualifies as a bank                  (7)      Approved non-bank trustee (attach copy of approval  
      (4)   Bank                                                                            letter) 
b     Type of submission (check one box):
      (1)   Not a mass submitter                                                   (2)      Mass submitter
      (3)   Identical adoption of a mass submitter                                 (4)      Minor modification of a mass submitter
6     Name of trustee or custodian 

      Number, street, and room or suite no. (If a P.O. box, see instructions.) 

      City or town, state, and ZIP code 

7     Type of funding entity: 
a      Trust                                 c                    Insurance company
b      Custodial account                                          Annuity contract or endorsement number (see instructions) ▶
                   Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge  
Please             and belief, it is true, correct, and complete. 
Sign      ▲                                                                                                    ▲
Here               Signature of officer                                                Date                     Title 
For Privacy Act and Paperwork Reduction Act Notice, see instructions.                           Cat. No. 11830C                  Form 5306 (Rev. 8-2013) 

Form 5306 (Rev. 8-2013)                                                                                                             Page  2 
Part II     Plan Information 
Attach a copy of the plan documents and indicate the article or section reference and the page number        Article or             For IRS  
                                                                                                                              Page  
where the following provisions appear. If an item does not apply, enter “N/A.” Sample language, or a listing Section                Use  
of required modifications (LRMs), is available on the IRS  website atIRS.gov. Type “LRM” in the search box.              Number     Only 
Sponsors are encouraged to use LRM language.                                                                 Reference 

   8a Does the IRA provide that the trust is created for the exclusive benefit of the participant  
      or  his  or  her  beneficiaries,  or  that  the  annuity  contract  must  be  owned  only  by  the  
      annuitant?        . . . .      . . .     .  .   .    . . .   . .   .    . .  . .   .  .   . .    .                            1/13 
   b  Does  the  IRA  describe  the  type  of  allowable  contributions  (that  is,  only  cash  except 
      for rollovers) and maximum limitation?  .            . . .   . .   .    . .  . .   .  .   . .    .                            2/14 
   c  Does  the  IRA  prohibit  the  investment  of  trust  assets  in  collectibles,  or  contain  a  
      statement  informing  individuals  that  an  investment  in  collectibles,  except  for  
      investments  in  certain  coins  and  precious  metals,  will  be  treated  as  a  taxable  
      distribution?  .    . . .      . . .     .  .   .    . . .   . .   .    . .  . .   .  .   . .    .                            3 
   d  Does the IRA prohibit investment in life insurance contracts?  .          .  . .   .  .   . .    .                            4 
   e  Does the IRA provide the rules on required distributions commencing before death?  .                                          5/15 
   f  Does the IRA provide the rules on required distributions commencing after death?                 .                            6/16 
   g  Does the IRA provide that the account is nonforfeitable?  .             . .  . .   .  .   . .    .                            7/17 
   h  Does the IRA provide that the contract is nontransferable?              . .  . .   .  .   . .    .                            18 
   i  Does the IRA provide for application of premium refund (other than refunds attributable  
      to excess contributions) before the end of the calendar year following the year of the  
      refund toward the payment of future premiums or the purchase of additional benefits?                                          19 
   j  Does the IRA prohibit commingling assets of trusts?            .   .    . .  . .   .  .   . .    .                            8 
   k  Does the IRA provide that annuity contracts must have flexible premiums?  .               . .    .                            20 
   l  Does the IRA provide for a separate accounting for the interest of each employee or  
      member of the association? .       .     .  .   .    . . .   . .   .    . .  . .   .  .   . .    .                            9 
   m  Does the IRA provide for annual calendar-year reports by trustees or issuers?  .            .    .                            10/21 
   n  Does  the  IRA  require  substitution  of  non-bank  trustee  or  custodian  when  notified  by  
      the Commissioner of the Internal Revenue Service?  .           .   .    . .  . .   .  .   . .    .                            11 
   o  Does the IRA define compensation?  .            .    . . .   . .   .    . .  . .   .  .   . .    .                            12/22 
                                                                                                                         Form 5306 (Rev. 8-2013) 

Form 5306 (Rev. 8-2013)                                                                                                     Page  3 
General Instructions                        Where to file. File Form 5306 with the      You are not required to provide the  
                                            Internal Revenue Service, Attention: EP     information requested on a form that is  
Section references are to the Internal      Opinion Letters, P.O. Box 27063,            subject to the Paperwork Reduction Act  
Revenue Code unless otherwise noted.        McPherson  Station, Washington, DC          unless the form displays a valid OMB 
Future developments.  For the latest        20038.                                      control  number. Books or records 
                                                                                        relating to a form  or its instructions must 
information about developments related      Address. Include the suite, room, or        be retained as long  as their contents 
to Form 5306 and its instructions, such     other  unit number after the street         may become material in  the 
as legislation enacted after this form and  number. If the  Post Office does not        administration of any Internal Revenue  
instructions were published, go to          deliver mail to the street  address and     law. 
www.irs.gov/form5306.                       you have a P.O. box, show the  box          Generally, tax returns and return  
Purpose of form. Sponsoring                 number instead of the street address.       information are confidential, as stated in  
organizations, employers, or employee       Signature. An officer who is authorized     section 6103. However, section 6103 
associations, use Form 5306 to request      to  sign or another person authorized       allows or requires the Internal Revenue 
a ruling as to:                             under a  power of attorney must sign this   Service to disclose or give such 
• Whether a trust or custodial account      application. Send the power of attorney     information to the Department of Justice 
agreement meets the  requirements of        with this application when you file it.     for civil and criminal litigation, and to 
section 408(a), 408(c),  408(p), or 408A,                                               cities, states, the District of Columbia, 
or                                          Specific Instructions                       U.S. commonwealths and possessions 
                                                                                        for use in administering their tax laws. 
• Whether an individual  annuity meets      User fee. All applications must be          We may also disclose this information to 
the requirements of section  408(b),        accompanied by the appropriate user         other countries under a tax treaty, to 
408(p), or 408A.                            fee. Applications submitted without the     federal and state agencies to enforce 
                                            proper user fee will not be processed       federal nontax criminal laws, or to 
Who May File                                and will be returned to the applicant.      federal law enforcement and intelligence 
Opinion letters on prototype IRAs.          To find the proper user fee, see Rev.       agencies to combat terrorism.  
Form 5306 may be filed by  a sponsoring     Proc. 2013-8, 2013-1 I.R.B. 237,            The time needed to complete and file 
organization that is:                       available at                                this  form will vary depending on 
• A bank (including savings and loan        www.irs.gov/irb/2013-01_IRB/ar13.html       individual  circumstances. The estimated 
associations that qualify as banks and      or the current superseding revenue          average time is: 
federally insured credit unions),           procedure. 
                                                                                        Recordkeeping    .  .  . 11 hr., 43 min. 
• Any person who has IRS approval to        Line 2c. If you are amending your plan, 
act  as a trustee or custodian,             enter the file folder number, letter serial Learning about the 
                                            number, and date from the latest opinion    law or the form  .  .  .  .   .   53 min. 
• An insurance company,                     letter you received for your plan.          Preparing and sending 
• A regulated investment company, or        Line 7c. Identify the endorsement,          the form to the IRS    .  .  1 hr., 7 min. 
• A trade or professional society or        contract, or both for which you are         If you have comments concerning the  
association (other than employee            requesting an opinion letter.               accuracy of these time estimates or  
associations).                                                                          suggestions for making this form 
Rulings under section 408(c).               Privacy Act and Paperwork                   simpler,  we would be happy to hear 
Employers or employee  associations         Reduction Act Notice                        from you. You can send us comments 
                                                                                        from www.irs.gov/formspubs/. Click on 
who want a ruling under  section 408(c)     We ask for the information on this form     "More Information" and then on 
for a trust which will be  used for         to  carry out the Internal Revenue laws of  "Comment on Tax Forms and 
individual retirement accounts  may file    the  United States. We need it to ensure    Publications." Or you can send your 
this form. The term “employee               that you are complying with these laws      comments to Internal Revenue Service, 
association” means any organization         and to allow us to figure and collect the   Tax Forms and Publications Division, 
composed of two or more employees,          right amount of tax. This information is    1111 Constitution  Ave. NW, IR-6526, 
including, but not limited to, an           needed to process your application and      Washington, DC 20224. Do not send the 
employee  association described in          to determine whether your individual        form to this address. Instead, see Where 
section 501(c)(4).                          retirement account or individual            to file. 
Who does not need to file. Sponsors of      retirement annuity meets the 
programs that use any of the Form 5305      requirements of section 408(a),  408(b), 
series of model forms should not submit     408(c), 408(p), or 408A. You are not 
their programs to the Internal Revenue      required to apply for approval; however, 
Service. These model forms, issued by       if you want to receive a ruling from the 
the  Service, contain language that, if     IRS regarding your prototype or 
followed, will  satisfy the applicable      employee sponsored individual 
statutory requirements.                     retirement arrangement, you are required 
                                            to provide the information requested on 
What to file. File Form 5306 and a copy     this form. Section 6109 requires you to 
of  the trust, custodial account, or        provide the requested identification 
annuity  contract and all other applicable  numbers. Failure to provide the 
documents. If you are requesting an         information may delay or prevent 
opinion letter for an annuity where all the processing your application; providing 
Internal Revenue Code requirements are      any false information may subject you to 
set forth in a separate endorsement that    penalties.
supersedes any conflicting language in 
any contract to which it may be 
attached, submit the endorsement and 
not the contract.