Actuary Certification IRS

Fill in the fields below to build your actuarial certification. The preview updates as you type. Edit the template text if needed for custom language. Download as Word or PDF when ready. See Example Excel.

Related Guidance:

IRS Actuarial Information

Plan Name

Plan Year Begin

Plan Year End

Valuation Date

Actuary Name

Enrollment Number

Firm Name

Firm URL (optional)

Actuary Phone

Actuary Email

Live Preview

Edit certification text (use placeholders: {PLANNAME}, {YEARBEG}, {YEAREND}, {VALDATE}, {ACTUARY}, {ENNUM}, {EAFIRM}, {EAPHONE}, {EAEMAIL})

Actuary Certification IRS

Related Guidance:

Certification Form Inputs