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.

Form NameFidelity Self Employed 401 K Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesfidelity self employed 401k contribution form, fidelity 401 k remittance form, fidelity solo 401k calculator, fidelity self employed 401k contribution remittance form

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Questions? Go to 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 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 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


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)








$ 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.









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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How to Edit Fidelity Self Employed 401 K Form Online for Free

The PDF editor can make filling in files stress-free. It is extremely effortless to change the [FORMNAME] file. Keep up with all of these steps in an attempt to do it:

Step 1: On the following web page, click the orange "Get form now" button.

Step 2: When you have accessed the fidelity self employed 401k contribution form editing page you can discover the different options you may perform relating to your file from the upper menu.

The PDF file you are going to prepare will consist of the next segments:

fidelity 401k contribution form gaps to fill out

Complete the Plan Administrator, Daytime Phone, Extension, Contribution Information All, Employee Name, Fidelity Account Number, Employee k Contribution, Current Year CYP Prior Year PYP, Employer Profit Sharing, Total Contribution, To the extent applicable include, Total, Authorization, By signing below you Understand, and comply with applicable areas with any details that can be asked by the program.

Filling in fidelity 401k contribution form step 2

The program will ask you to write certain relevant information to easily fill in the area PRINT PLAN ADMINISTRATOR OR, PLAN ADMINISTRATOR OR EMPLOYER, DATE MMDDYYYY, N X, I S, On this form Fidelity means, and Page of.

Finishing fidelity 401k contribution form stage 3

Step 3: Click the button "Done". Your PDF document may be transferred. It is possible to upload it to your device or send it by email.

Step 4: To prevent probable future problems, you should hold at least several copies of each separate form.

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