Fidelity Self Employed 401 K Form – Fill Out and Use This PDF

Fidelity Self Employed 401 K Form is a great way to start saving for retirement. The form describes how much you contributed and how it was invested.

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Fidelity Self Employed 401 K Form PDF Details

If you are self-employed, you may be wondering if there is a way to save for retirement. Luckily, there is a great option available: the Fidelity Self Employed 401 K Form. This form allows you to save for retirement using tax-deductible contributions. In addition, the money you save in this account can grow without being taxed until you withdraw it in retirement. This makes it a great option for those who want to save for retirement on their own schedule.

Here is the data concerning the form you were in search of to fill out. It can tell you how much time it may need to complete fidelity self employed 401 k form, exactly what fields you need to fill in, and so forth.

Question	Answer
Form Name	Fidelity Self Employed 401 K Form
Form Length	1 pages
Fillable?	Yes
Fillable fields	27
Avg. time to fill out	5 min 43 sec
Other names	fidelity 401k contribution remittance form, fidelity 401k contribution form, solo 401k calculator fidelity, fidelity self employed 401k contribution form

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Questions? Go to Fidelity.com/smallbusiness or call 800-343-3548.

Self-Employed 401(k) — Contribution Remittance Form

Use this form to submit contribution deposits to your Fidelity Self-Employed 401(k) Plan account(s). Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information, make a copy of this form.

Make check(s) payable to Fidelity Investments and mail to:

•Regular mail: Fidelity Investments, P.O. Box 770001, Cincinnati, OH 45277-0003

•Overnight mail: Fidelity Investments, 100 Crosby Parkway, KC1H, Covington, KY 41015

Helpful to Know

• Be sure to indicate below how to allocate contributions for each	limits are not exceeded. Refer to Fidelity.com/smallbusiness for
plan participant to the applicable contribution sources: Employee	applicable limits.
401(k) and/or Employer Profit Sharing Contributions.	• Contributions will be deposited in each participant’s core

• If we are unable to allocate contributions to the sources	account. Participants can place a trade in their account by going
indicated, we will deposit them as Employer Profit Sharing	to Fidelity.com or by calling Fidelity.
Contributions, and will then contact you on how to resolve them.	• Please keep a copy of your completed contribution remittance

• Note: It is your responsibility to separately account for each of the	form for your records.
two different contribution types to ensure that applicable annual

1. Employer Information

Employer Name (i.e., Company Name)

Employer Tax ID Number

Plan Administrator

Daytime Phone

Extension

2.Contribution Information All deposits may be subject to a four-business-day clearing period.

Employee Name	Fidelity Account Number	Employee 401(k) Contribution		Employer Profit Sharing		Total Contribution
				Contribution (CCR)*
		Current Year (CYP)	Prior Year (PYP)	Contribution (CCR)*
		$	$	$		$ 0.00

		$	$	$		$ 0.00

		$	$	$		$ 0.00

*To the extent applicable, include any safe harbor nonelective contributions.					Total $ 0.00

3. Authorization

By signing below, you:

•Understand that you are required to comply with applicable contribution limits and deadlines.

•Hereby authorize Fidelity Brokerage Services LLC (“Fidelity”) to deposit the dollar amounts to the designated account(s), as instructed above.

•Understand that it is your responsibility to allocate contributions to the appropriate employee and contribution source correctly. Failure to clearly designate a contribution type may result in the entire check being returned to you for further instructions, for which Fidelity will not be responsible for delay(s) in contributions.

•Agree to fully indemnify and hold Fidelity and its affiliates harmless for any liability that may arise from Fidelity acting upon your instructions.

PRINT PLAN ADMINISTRATOR OR EMPLOYER NAME

PLAN ADMINISTRATOR OR EMPLOYER SIGNATURE

<![endif]>SIGN	X

DATE MM/DD/YYYY

X

On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 390265.5.0 (06/17)

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fidelity 401 k remittance form gaps to fill out

Complete the Daytime, Phone Extension, Employee, Name Fidelity, Account, Number Employee, k, Contribution Current, Year, CY, P, Prior, Year, PY, P Total, Contribution and Total areas with any details that can be asked by the program.

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