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SIMPLE IRA transmittal form
Introduction
Instructions
Please use this form each time you send SIMPLE IRA contributions to John Hancock Investments. Be sure
to differentiate between Employee and Employer contributions and include your Plan ID number.
Special considerations
According to the U.S. Department of Labor, Employee deferral deposits must be made within 30 calendar
days of the end of the month in which the amount was withheld from the Employee’s pay.
Questions about this form?
800-432-1969
Contact us:
800-432-1969
jhinvestments.com
See the end of this document for
return instructions
1. Contribution information
Contribution allocation for payroll ending:
Date (MM/DD/YYYY)
Name of Employer
Address
City
State
Zip code
2. Contribution breakdown
Participant
name
Social Security
number
Employee
contribution
Employer
contribution
Total
amount
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Total contribution for this period:
$
3. Mail
Please mail all Employer and Employee forms to:
Regular mail
Express mail
John Hancock Signature Services, Inc.
P.O. Box 55913
Boston, MA 02205-5913
John Hancock Funds, LLC Member FINRA, SIPC
601 Congress Street Boston, MA 02210-2805 800-225-5291
John Hancock Signature Services, Inc.
30 Dan Road
Suite 55913
Canton, MA 02021-2809
jhinvestments.com
NOT FDIC INSURED. MAY LOSE VALUE. NO BANK GUARANTEE. NOT INSURED BY ANY GOVERNMENT AGENCY.
SIRATFM 9/15
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