Fillable Bank Wire Form Standalone (Fidelity Investments)

Fill Online, Printable, Fillable, Blank Bank Wire Form Standalone (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.

Bank Wire Form Standalone (Fidelity Investments)

On average this form takes 6 minutes to complete

The Bank Wire Form Standalone (Fidelity Investments) form is 3 pages long and contains:

  • 0 signatures
  • 1 check-box
  • 25 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
 
Questions? Go to Fidelity.com/transfermoneyshares or call 800-343-3548.
Bank Wire Authorization
Use this form to establish standing bank wire instructions on your Fidelity account(s), including eligible retirement and nonretirement
accounts. Do NOT use this form to request a specific transaction. Type on screen or fill in using CAPITAL letters and black ink. If you
need more room for information or signatures, make a copy of the relevant page.
Helpful to Know
• Bank wire can be used to make urgent transfers FROM Fidelity
to your account or someone else’s account at a bank or
financial institution.
• Bank wire will become available immediately after the feature is
established on your account(s).
• Any transaction in your Fidelity IRA initiated with the
instructions you create will result in a distribution from your
Fidelity IRA and will be reported to the IRS. Note that:
– Such distribution will generally result in taxable income to
you for the year distributed to you, unless it is rolled over
to another IRA or qualified employer plan within 60 days. It is
your responsibility to ensure that the subsequent account
is qualified to accept rollover amounts.
• Do not use bank wire to purchase an investment directly with
another institution outside Fidelity.
• A Medallion signature guarantee is required.
• Bank wire is not available for:
– Self-Employed 401(k)
– Workplace Self-Directed Brokerage
– Fidelity Retirement Plan (Keogh)
– Investment-Only Retirement Account (Non-Prototype)
– Health Savings Account (HSA)
• Online Transaction Limits:
– Minimum Daily Limit: $100
– Maximum Daily Limit: $100,000
• The Bank may charge a fee for receiving wires.
1. Account Owners
Name
Additional Owner/Authorized Individual Name
2. Fidelity Account(s)
Provide your Fidelity account number(s) for establishing bank wire:
Fidelity Account Number Fidelity Account Number Fidelity Account Number
Be sure each account
listed is eligible for
bank wire.
1.9866439.105 Page 1 of 3 033710301
Form continues on next page.
Print
Reset
Save
1.9866439.105 Page 2 of 3 033710302
3. Bank Wire Standing Instructions Use to transfer money FROM Fidelity to your
account or someone else’s account at a bank, credit union, or other financial institution.
Provide bank account information to set up the bank wire feature. The bank or financial institution may charge additional fees
for receiving bank wires.
Wire Recipient
Bank Routing /ABA Number Bank Name
Account Number Account Owner Name(s) Required
Address of Wire Recipient
City State/Province ZIP/Postal Code Country
For Further Credit
Additional Details (if applicable) Instructions to be included with the wire transfer.
Correspondent (Intermediary)
Correspondent Bank Routing/ABA Number Correspondent Bank Name
Account is OUTSIDE the United States:
SWIFT Code Name of Country
4. W-8-Certified Customers Explanation for standing instructions requested for a country different
from the country of tax residence.
If you are requesting standing instructions to send money to a financial institution in the United States or in a country different from the
treaty country listed on your W-8, provide the reason below.
Reason 250 characters maximum
5. Signature and Date Form cannot be processed without signature and date.
ALL businesses and entities must also complete Section 6 on the next page.
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC and National Financial Services LLC and their affili-
ates, and their employees, agents, representatives, shareholders, successors, and assigns as the context may require; “you” and “account
owner” refer to the owner indicated on the account form; and for any account with more than one owner (such as a joint or trust account),
“you” and “account owner” or “account owners” refer to all owners, collectively and individually.
By signing below, you:
• Authorize Fidelity to act on all instructions
given in this form.
• Accept all terms and conditions described
in this form.
• Certify that all information you provided
is correct.
• Agree, if you are a trustee, a custodian,
or the fiduciary of an employer-sponsored
retirement plan, that you are responsible
for complying with your legal and fiduciary
obligations.
• Authorize us, upon receiving instructions
from you or as otherwise authorized
by you, to make payments from you
by credit entries to the account at the
financial institution indicated in the form
(Bank). You authorize the Bank to process
such entries and to credit the account
at that Bank for such entries. You ratify
such instructions and agree that neither
we nor any mutual fund will be liable
for any loss, liability, cost, or expense
for acting upon all such instructions
believed to be genuine if we employ
reasonable procedures to prevent
unauthorized transactions. You agree that
this authorization may only be revoked
by written notice to us in such time and
manner as to afford us and the Bank a
reasonable opportunity to act upon it.
• Acknowledge that Fidelity will not be
liable for any loss, expense, or cost arising
out of your instructions, provided that it
institutes reasonable procedures to pre-
vent unauthorized transactions.
For Business Accounts, if you are the sole
officer, you:
• State that you are authorized to enter
into these transactions on behalf of
the organization.
• State that you are the sole officer of, and
the sole individual authorized to act on
behalf of, the registered owner.
All bank wire
requests MUST
have a Medallion
signature guarantee.
A notary seal/stamp is
NOT a Medallion
signature guarantee.
FULL address is
required for
international wires.
If the bank uses a
correspondent bank,
provide the information here.
Correspondent bank
information may not be
required for all wires.
Indicate if the recipient
bank is outside the
United States.
Required to be
completed if
applicable.
Signature and Date continues on next page.
One authorized signature is required unless you have a Mutual Fund Account (the account number begins with a
2 followed by two letters), in which case all owners must sign.
A Medallion signature guarantee is required to establish bank wire instructions.
If the form is completed at a Fidelity Investor Center, the Medallion signature guarantee is not required. You can get a Medallion signature
guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a Medallion signature guarantee.
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
6. Business/Entity Account Certification All businesses and entities must review this section.
If there is only one officer, that officer must sign in Section 5. If there is more than one officer, an authorized
individual other than those signing in Section 5 must also sign below in this Section 6.
By signing below, you:
• State that the individual(s) signing above is (are) authorized to enter into these transactions on behalf of the organization.
• State that, if you are the same individual signing above, that you are the sole officer of, and the sole individual authorized to act on behalf
of, the registered owner.
A Medallion signature guarantee is required to establish bank wire instructions.
If the form is completed at a Fidelity Investor Center, the Medallion signature guarantee is not required. You can get a Medallion signature
guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a Medallion signature guarantee.
PRINT AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
PRINT AUTHORIZED INDIVIDUAL TITLE
AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
1.9866439.105 Page 3 of 3 033710303
5. Signature and Date, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 732215.6.0 (11/18)
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” confirming your updates.
Questions? Go to Fidelity.com/transfermoneyshares or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0002
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
Use the postage-paid envelope, drop off at a
Fidelity Investor Center, OR deliver to:
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

Bank Wire Form Standalone (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 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document