Fidelity NetBenefits Send a Document Form Completed Form Examples and Samples
Browse real-world examples of completed Fidelity NetBenefits Send a Document Form submissions. Each sample shows exactly how to fill out the form correctly for beneficiary changes, life events, rollover requests, and more — helping you avoid errors and processing delays.
Fidelity NetBenefits Send a Document Form Example – Beneficiary Designation Change
How this form was filled:
In this example, a plan participant submits a completed Beneficiary Designation form through the Fidelity NetBenefits Send a Document portal. The participant's full name, Social Security Number, and employer plan details are provided. The document type is clearly identified, the plan number is included, and the form is signed and dated in early 2026.
Information used to fill out the document:
- Participant First Name: Michael
- Participant Last Name: Torres
- Middle Initial: R
- Social Security Number (Last 4 Digits): 7842
- Date of Birth: 03/15/1985
- Employer / Plan Sponsor Name: Horizon Manufacturing Group
- Plan Name: Horizon Manufacturing Group 401(k) Savings Plan
- Plan Number: 72345
- Document Type Being Submitted: Beneficiary Designation Form
- Reason for Submission: Life Event – Marriage
- Mailing Address: 4821 Elmwood Drive, Columbus, OH 43215
- Daytime Phone Number: (614) 555-0193
- Email Address: [email protected]
- Preferred Contact Method: Email
- Signature: Michael R. Torres
- Date of Submission: 01/14/2026
What this filled form sample shows:
- Correctly identified document type as Beneficiary Designation Form for accurate routing within the NetBenefits system
- Accurate plan number and employer name ensuring the document is matched to the correct retirement account
- Life event reason (marriage) noted to support timely processing of the beneficiary update
- Complete participant contact information including phone, email, and mailing address to prevent processing delays
- Properly formatted signature and submission date of January 14, 2026, satisfying authentication requirements
- Last four digits of Social Security Number provided for identity verification without exposing full SSN
Form specifications and details:
| Use Case: | Submitting a Beneficiary Designation Change form following a qualifying life event (marriage) |
| Form Name: | Fidelity NetBenefits Send a Document Form |
| Plan Type: | 401(k) Defined Contribution Retirement Plan |
| Submission Method: | Fidelity NetBenefits Online Document Upload Portal |
| Document Category: | Beneficiary Designation |
| Life Event Trigger: | Marriage |
| Processing Institution: | Fidelity Investments – NetBenefits |
| Submission Year: | 2026 |
| Identity Verification Method: | Last 4 digits of SSN plus Date of Birth |
| Turnaround Expectation: | 5–7 business days after receipt |
Created: February 25, 2026 06:21 AM
