Model Certificatio Model Certification

CERTIFICATION THAT THE PLAN AMENDMENT
TO REINSTATE SUSPENDED BENEFITS WILL BE TIMELY ADOPTED
As required by 29 C.F.R. § 4262.7(e)(2) for the application for special financial assistance for
the [NAME OF PLAN] (the “Application” for the “Plan”), we, [CHOOSE EITHER: ‘the’ OR
‘as’] members of the Board of Trustees of the Plan hereby certify that the proposed amendment
to the [NAME AND DATE OF CURRENT PLAN DOCUMENT] to reinstate benefits under the
Plan that have been suspended under [CHOOSE EITHER: ‘section 305(e)(9) of ERISA’ OR
‘section 4245(a) of ERISA due to plan insolvency’], which proposed amendment is submitted
herewith as part of the Application, will be timely adopted upon approval by the Pension Benefit
Guaranty Corporation of the Application.
[INCLUDE ONLY IF LESS THAN THE ENTIRE BOARD OF TRUSTEES IS SIGNING:] Section
[REFERENCE TO APPROPRIATE PROVISION] of the [NAME AND DATE OF PLAN’S
CURRENT TRUST DOCUMENT], as amended, authorizes [DESCRIBE HOW TRUST
DOCUMENT OR OTHER GOVERNING DOCUMENT AUTHORIZES THE SIGNERS BOTH
TO SIGN ON BEHALF OF ENTIRE BOARD AND TO COMMIT THE BOARD TO TIMELY
ADOPT THE AMENDMENT AFTER THE PLAN’S APPLICATION FOR SPECIAL FINANCIAL
ASSISTANCE IS APPROVED].
[INSERT ONE SIGNATURE BLOCK FOR EACH TRUSTEE, EACH WITH A PRINTED NAME
AND TITLE:]
___________________________
[PRINTED NAME]
[TITLE]

___________________________
[PRINTED NAME]
[TITLE]

___________________________
[PRINTED NAME]
[TITLE]

___________________________
[PRINTED NAME]
[TITLE]

Date: [DATE OF EXECUTION]

- Certification of Benefit Reinstatement, Page 1 of 1 -