DOL e-file Signature and Filing Authorization
DOL e-file Signature and Filing Authorization for the Form 5500 Series Report
Name of Plan:
EIN / PN:
Plan Year Ending:
PART I (a) Return Information (in whole dollars) – Pension Plans Only
Total employer contributions - $
Net assets available for benefits - $
PART I (b) Return Information – Welfare Plans Only
Total active participants as of the end of the plan year - ______
PART II Declaration and Signature of Authorized Signer
Under penalties of perjury, I declare that I have examined the return/report, including all applicable schedules, and to the best of my knowledge and belief, it is true, correct, and complete.
I further declare that the information provided in Part I above is the same as shown on Form
5500. I hereby authorize ____________________ to enter their EFAST2 PIN on our return/report in order to electronically submit this return/report. I understand that by selecting this electronic signature option the PDF image of my manual signature will be included with the rest of the return/report posted by the Department of Labor on the Internet for public disclosure.
This authorization is applicable only to the filing for the above-named Plan and applies only for
Plan year end stated above.
Plan Administrator: ______________________________________________ Date: _________
Plan Sponsor: ___________________________________________________ Date: _________
(If not the Plan Administrator)
PART III Certification of Designated Service Provider
On behalf of the service provider designated above, I hereby certify that the firm will use the authority granted only for the express purposes described above.
For the service provider: _________________________________________ Date: __________
(Signature and title)
The designated service provider must retain this authorization.
Do not submit this form to the DOL unless requested to do so.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- ca 1 fillable word form
- form 106 kentucky labor cabinet
- labor and industries
- national interagency fire center
- standard form 3881 ach vendor miscellaneous
- authorization and consent workforce connections
- department of labor licensing and regulation
- home page alaska department of labor and
- employer authorization for the release
- dol e file signature and filing authorization
Related searches
- e learning advantages and disadvantages
- e commerce advantages and disadvantages
- e file pa taxes free
- e file form 941 free
- e file form 941 irs
- e commerce advantage and disadvantage
- dol personnel file requirements
- e business definition and examples
- e publishing tongue and quill
- e business advantages and disadvantages
- e file hardship waiver reasons
- irs 990 e file postcard