Form 2 - Contribution And Loan Repayment Remittance
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4Form 2 08/16
CONTRIBUTION AND LOAN REPAYMENT REMITTANCE FORM
ABA Retirement Funds Program (“the Program”)
Plan Administrator Line: 800.752.6313
P.O. Box 5142 • Boston, MA 02206-5142
Website:
The Authorized Plan Representative completes all sections of this form to remit contributions and loan repayments. Section 2 is for contributions, section III is for catch-up contributions and
section 4 is for loan repayments. Mail the original, signed form to the address shown above. For section 2, Contribution Type/Amounts: Enter the contribution dollar amount in the appropriate
“Contribution Type” column. Refer to your plan’s Adoption Agreement if you are unsure as to which types are allowed under your plan.
1. EMPLOYER INFORMATION
Program Plan Number: ___ ___ ___ ___ ___ ___ Employer Tax ID Number: ___ ___ – ___ ___ ___ ___ ___ ___ ___ IRS Plan Number: ___ ___ ___
Employer’s Name: ______________________________________________ Employer’s Business Phone Number: ( ______ ) ______ – ____________
2. CONTRIBUTION REMITTANCE (USE ADDITIONAL PAGES IF NECESSARY.)
___ ___ /___ ___ /___ ___ ___ ___
___ ___ /___ ___ /___ ___ ___ ___
________.
For Firm’s Plan Year Ending
401(k) Salary Deferrals (which may include catch-up contributions) are for payroll date
or calendar year
CONTRIBUTION TYPE
A* / B*
N
C
D
F
G
P*/ T*
401(k) SALARY DEFERRAL**
ROTH 401(k)
QNEC/
EMPLOYER
EMPLOYER
POST-TAX
SAFE HARBOR EMPLOYER
PARTICIPANT
SOCIAL SECURITY NUMBER
or SIMPLE 401(k)
CONTRIBUTIONS**
QMAC**
MATCHING
EMPLOYEE**
MATCHING** or EMPLOYER
NAME
(REQUIRED)
SALARY DEFERRAL**
NON-ELECTIVE**
TOTAL
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
__________________ __________________ $_______________ _______________ _______________ _______________ _______________ _______________ _______________ $_______________
Contribution Subtotal $ _________________________________________
Page 1 of 4
* Based on your plan design.
(Transfer this total to the Remittance Totals, Section 5.)
** These contributions are 100% vested. Please ensure that no negative figures are included.
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