Fillable Address / Name Change Annuities (Fidelity Investments)

Fill Online, Printable, Fillable, Blank Address / Name Change Annuities (Fidelity Investments) Form

Use Fill to complete blank online FIDELITY INVESTMENTS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Address / Name Change Annuities (Fidelity Investments)

On average this form takes 10 minutes to complete

The Address / Name Change Annuities (Fidelity Investments) form is 2 pages long and contains:

  • 0 signatures
  • 2 check-boxes
  • 39 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Fidelity Investments forms online.

BROWSE FIDELITY INVESTMENTS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Page 1 of 3
Address / Name Change – Annuities
Use this form to notify Fidelity that the name, address, or phone number of a contract owner or authorized individual has changed.
Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room for information or signatures, use a copy
of the relevant page.
Helpful To Know
• You must already be a contract owner or an authorized
individual (trustee, custodian, etc.) in order to change a
name or the address on an account.
• Changes requested on this form will be made on all Fidelity
annuities you own or are an authorized individual on.
• You must either:
- attach a photocopy of a marriage certificate, divorce
decree, or other court document showing your new name
- get a signature guarantee
1. Contract Owner / Authorized Individual
Owner Name
Annuity Contract Number
Joint Owner / Authorized Individual Name
2. New Address of Contract Owner(s)
Legal / Residential Address
Address
City State/Province Zip/Postal Code Country
Evening Phone Daytime Phone Extension
Mailing Address
Same as legal / residential address
Default if no other information indicated below.
Address
City State/Province Zip/Postal Code Country
3. New Address of Joint Owner / Authorized Individual
Complete ONLY if a joint owner / authorized individual has a separate address. Addressee must already be an owner / authorized individual.
Addressee If different than above
Legal / Residential Address
Address
City State/Province Zip/Postal Code Country
Evening Phone Daytime Phone Extension
Questions on your annuity? Call 1-800-634-9361.
1.925747.108 025770401
Provide the address
used for tax
reporting. Cannot
be a PO Box, Mail
Drop, or C/O.
Provide the address
used for tax
reporting. Cannot
be a PO Box, Mail
Drop, or C/O.
Print
Reset
Mailing Address
Same as legal / residential address
Default if no other information indicated below.
Address
City State/Province Zip/Postal Code Country
4. Contract Owner / Authorized Individual Name Change
Former Name
First Name M.I. Last Name Social Security or Taxpayer ID Number
New Name
First Name M.I. Last Name
5. Signature and Date Owner(s) / authorized individual(s) requesting change must sign and date.
By signing below, you:
• Authorize Fidelity to act on all instructions given on this form.
• Accept all terms and conditions described in this form.
• Certify that all information you provided is correct to the best of your knowledge.
A Medallion Signature Guarantee is required for a name change if no court document is available. You can get a Medallion Signature
Guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a signature guarantee.
Print Owner Name
Owner / Authorized Individual Signature Date MM-DD-YYYY
SIGN
Print Joint Owner / Authorized Individual Name
Joint Owner / Authorized Individual Signature Date MM-DD-YYYY
SIGN
Individual providing signature guarantee Providing this information will avoid delay or rejection of your request.
Guarantor Name Phone Extension
Attach a photocopy
of a marriage
certificate, divorce
decree, or other
court document
showing the new
name or get a
signature guarantee.
1.925747.108 025770402Page 2 of 3
MEDALLION SIGNATURE GUARANTEE
MEDALLION SIGNATURE GUARANTEE
1.925747.108 025770403 Page 3 of 3
Fidelity insurance products are issued by Fidelity Investments Life Insurance Company (FILI), and, in
New York, by Empire Fidelity Investments Life Insurance Company
®
, New York, N.Y. FILI is licensed
in all states except New York. Other insurance products available at Fidelity are issued by third-party
insurance companies, which are not affiliated with any Fidelity Investments company. A contract’s
financial guarantees are subject to the claims-paying ability of the issuing insurance company.
Fidelity Brokerage Services LLC, Member NYSE, SIPC. 574748.8.0 (12/19)
Did you sign the form and attach
any necessary documents? Send the
ENTIRE form and any attachments to
Fidelity Investments. You will receive
a Revised Account Profile.
Questions? Call 1-800-634-9361.
Regular Mail
Except NY Regular Mail NY Only Overnight Mail
Annuity Service Center
PO Box 770001
Cincinnati, OH 45277-0050
Annuity Service Center
PO Box 770001
Cincinnati, OH 45277-0051
Fidelity Investments
100 Crosby Parkway, KC2Q
Covington, KY 41015
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Address Name Change Annuities (Fidelity Investments)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 8 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document