Solo 401(k) Application

We look forward to helping you unlock your retirement plan and start investing as you choose with a  Safeguard Solo 401(k).  Please provide the information below and we’ll get started promptly.

Please review our Solo 401(k) Terms of Service before you begin.

If you would prefer, you may download a Solo 401(k) Application to complete offline.  Use this option if you wish to pay by check.

For assistance with the application, please call 877-229-9763 or schedule a call with a member of our team.

"*" indicates required fields

Contact Information

Tell us about you.

Plan Participant & Primary Trustee*

Please enter your full legal name.

Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First M.I. Last Suffix

Phone*

Primary/Daytime Phone Number

Email*

Primary email address

Primary/Tax Address*

No PO boxes allowed. Will be used as official tax address of plan.

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code

County / Parish*

Please enter the county or parish associated with your address.

Enter a different shipment address

Shipping Address

Please let us know where to ship your plan documents if different than your primary address.

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Enter a different billing address

Billing Address

Please provide the billing address for your payment card if different than the primary address.

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Business Information

Tell us about the business that will sponsor the Solo 401(k).

Employer Name*

Your business sponsoring the 401(k) as an employee benefit plan. Your name if you are a sole proprietor.

Business Entity Type*

What is the business type?

Sole Proprietorship

LLC (Incl. LLC taxed as S-Corp.)

Partnership / LLP

S-Corporation

C-Corporation

Other

Date of Incorporation*

Enter date of business formation for a corporation.

Tax Year End Date*

Enter the last date of the tax year if other than December 31 (MM/DD),

Last 4 Digits of Employer EIN*

Optional: Enter the last 4 digits of the EIN of the sponsoring employer if a business or your SSN if a sole proprietor.

Other Plans Sponsored by This Business*

Has this business that will be setting up the Solo 401(k) sponsored one or more of the following employee benefit retirement plans (past or current).

No Prior Employer Plans

401(k) or other qualified employer plan

SEP IRA

SIMPLE IRA

Additional Businesses*

Do you and/or your spouse have ownership in other businesses that may be considered a Control Group or Affiliated Service Group? If yes, we will contact you for additional details.

No

Yes

Integrated Plan Banking with Solera Bank

Safeguard Advisors partners with Solera National Bank for Solo 401(k) bank setup. Integrated banking with Solera simplifies your plan setup and helps get your plan funded faster. Solera support is great, and they are trained on and understand the special needs of self-directed 401(k) plans. If you choose to use Solera for plan banking, we will use information you provide here to pre-fill your Solera application.

Choose Solera Integrated Banking*

Yes. Setup my plan account(s) with Solera

No. I wish to setup an account on my own using a different bank.

Trustees & Participants

Tell us who will have control over the plan and who will hold retirement savings within the plan. If you choose to bank with Solera, any person who will have signing authority will be sent their own Solera application and need to provide identity verification.

Co-Trustee & Additional Particpant*

A co-trustee has discretionary power to administer the plan just like the primary trustee. A co-trustee may or may not also be a plan participant. A plan participant is a spouse or business partner who is employed by and compensated by the business, and will hold retirement savings within the plan.

No Co-Trustee

Appoint a Co-Trustee (non-participant)

Appoint a Co-Trustee who is also a plan participant

Co-Trustee Name*

Enter the full name of the Co-Trustee

Co-Trustee Address*

Same as Primary Address

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Co-Trustee Email*

Provide a unique email address for the co-trustee different from the one you provided for yourself.

Co-Trustee Phone*

Co-Trustee as Bank Signer*

Will your co-trustee need to have signing authority on plan bank accounts?

Yes. The Co-Trustee needs bank signing authority.

Bank Accounts to Setup

A separate bank account will be setup for each participant and tax type. Pease tell us the types of accounts you will need for your plan. An account needs to exist for any type of funds you plan to rollover or contribute to the plan. Contact your Safeguard consultant if you need assistance. You can skip this section and complete your application if you are unsure.

Primary Participant Accounts Needed

Traditional Tax-Deferred

Roth

Additional Participant Accounts Needed

Traditional Tax-Deferred

Roth

I Need Assistance

If you are unsure about account types, please check this box. Your Safeguard consultant will reach out to help. We need this information before we can setup your Solera Bank accounts, which is several days into the process.

Please contact me to help with bank accounts

Qualification and Acknowledgements

Please review the Safeguard Solo 401(k) Terms of Service before completing this section.

Representation of Plan Eligibility*

I represent that I am self-employed and have no full time employees as described in the Safeguard Solo 401(k) Terms of Service

3rd Party Designee*

I authorize Safeguard Advisors, LLC to act as a 3rd party designee on my behalf to apply for and receive an EIN for this 401(k) plan from the IRS, and to answer questions about completion of form SS-4.

Plan Document Subscription*

I subscribe to the Plan Document Maintenance service as outlined in the Safeguard Solo 401(k) Terms of Service. I authorize Safeguard to bill the credit card provided for the annual subscription amount of $125 in the anniversary month of plan delivery.

Terms of Service*

I have read and agree to the Safeguard Solo 401(k) Terms of Service

Digital Signature*

Enter full legal name

Payment

Fees for establishment of your Solo 401(k) may be paid by the sponsoring employer (potentially deductable) or from the Solo 401(k) once completed. If you elect the 30-Day deposit option, we'll bill the card provided if alternate payment is not provided within 30 days. You would still have the option to reimburse yourself from the plan for both the deposit and balance payments.

Safeguard Solo 401(k) Plan

Price:

Coupon Code

Enter a coupon code if one was provided with your plan proposal.

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Payment Option

Pay in Full

Pay $300 Deposit

Total Due Today

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043

  Security Code Cardholder Name

Comments

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