Employee Enrollment  ·  Pro

Streamline 401(k) Enrollment and Contribution Elections

Let employees enroll in your 401(k) plan, set pre-tax and Roth contribution rates, choose investments, and name beneficiaries in one easy online form.

Terra theme
formbuilder.ai/f/401k-retirement-savings-plan-employee-enrollment-contribution-election-form
401(k) Retirement Savings Plan Employee Enrollment & Contribution Election Form
Employee Full Name
· · ·
Social Security Number
· · ·
Date of Birth
· · ·
Submit

This free 401(k) Retirement Savings Plan Employee Enrollment and Contribution Election Form template gives employers a clear, convenient way to enroll staff in a company retirement plan. Employees provide their personal details, including full name, Social Security number, date of birth, date of hire, email, and mailing address. They then choose how much of their eligible pay to contribute each pay period. The form supports pre-tax (Traditional) and Roth 401(k) contributions and includes a total contribution rate field. It also offers optional catch-up contributions for employees age 50 and older and an automatic 1% annual increase option.

The template is designed for HR departments, payroll administrators, benefits coordinators, and small business owners. It captures investment elections, including a custom fund allocation that must total 100%, along with primary and contingent beneficiary designations. Employees can use it to enroll for the first time, change their contribution rate, stop contributions, or decline participation. A requested effective date tells payroll exactly when to apply each change.

Replacing paper enrollment packets with an online form reduces data entry errors, speeds up processing, and keeps every participant election organized in one place. Built-in instructions remind employees that contributions are subject to annual IRS limits. They also explain what to enter when stopping contributions or declining participation, so employees complete the form correctly the first time. Customize the fields, branding, and plan details to match your retirement plan. Then share the form by link or embed it on your benefits portal to make open enrollment and new-hire onboarding faster and easier.

4 Pages
19 Questions
~6min To complete
Free No credit card needed
Field types Date ×4 number ×2 Full Name Short Text Email Address Dropdown Calculation currency Yes / No Single Choice Table / Grid Repeatable Section termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Employee Information 6 questions
Employee Information
1 Employee Full Name * Full Name
2 Social Security Number * Short Text
3 Date of Birth * Date
4 Date of Hire * Date
5 Email Address * Email
6 Home Mailing Address * Address
Page 2 Contribution Election 7 questions
Contribution Election
Indicate how much of your eligible pay you would like to contribute each pay period. You may contribute on a pre-tax (Traditional) basis, a Roth 401(k) basis, or a combination of both. Your combined contributions are subject to annual IRS limits. If you are stopping contributions or declining participation, enter 0 in both percentage fields.
1 Election Type * Dropdown
2 Requested Effective Date * Date
3 Pre-Tax (Traditional) Contribution — % of Eligible Pay number
4 Roth 401(k) Contribution — % of Eligible Pay number
5 Total Contribution Rate (%) Calculation
6 Catch-Up Contribution per Pay Period (Age 50+ Only) currency
7 Would you like your contribution rate to increase automatically by 1% each year, up to the Plan maximum? Yes / No
Page 3 Investments & Beneficiaries 3 questions
Investment Elections & Beneficiary Designation
1 Investment Election * Single Choice
2 Custom Fund Allocation (Must Total 100%) Table / Grid
3 Beneficiary Designation (Primary and Contingent Shares Must Each Total 100%) * Repeatable Section
Page 4 Authorization & Signature 3 questions
Authorization & Signature
1 I certify that the information provided is accurate. I authorize my employer to withhold my elected contributions from each paycheck and deposit them into my 401(k) account until I submit a new election. I understand that contributions are subject to IRS limits and Plan rules and that investment returns are not guaranteed. If I make no investment election, my contributions will be invested in the Plan's default fund. If I am married and name someone other than my spouse as primary beneficiary, spousal consent may be required. * termsandconditions
2 Date Signed * Date
3 Employee Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Terra" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Free to use on any plan, no credit card required

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Free to use. Open in the editor, customize, and publish in minutes.

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Category Enrollment
Subcategory Employee Enrollment
Theme Terra
Badge Pro
Price Free
Coding required None

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