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Page 1 of 5
Questions? Go to Fidelity.com/movemoney or call 800-343-3548.
One-Time Withdrawal — Nonretirement
Use this form to make a one-time withdrawal from your nonretirement Brokerage or Mutual Fund Only account. Do NOT use this form
for retirement accounts, annuities, 529 college savings plan accounts, or ABLE accounts. Go to Fidelity.com/forms to find the appropriate
form. 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
•
If you are making withdrawals from more than one
account, you must complete a separate form for
each account.
•
If this transaction is an international wire subject to Part
B of the Electronic Funds Transfer Act, the transaction
cannot be completed until you consent to the
prepayment disclosure provided to you by telephone.
Provide your contact information in Section 1.
•
To transfer from this account to another Fidelity account,
go to Fidelity.com/forms to download the Transfer
Between Existing Fidelity Brokerage Accounts form.
• If this form directs Fidelity to sell shares of any security,
be aware that the timing of the transaction depends
on when we receive this form, which is outside of your
control. To better control the timing of the transaction,
you should direct the sale of securities online or through
a Fidelity representative. Note: Certain securities (such
as options, certain fixed income securities, and thinly
traded securities) may not be eligible to sell via this
form, which may result in Fidelity not being able to
process this withdrawal as requested.
•
For mutual funds, note that:
– Withdrawals could trigger redemption or transaction
fees (see the applicable fund prospectus).
– If a fund is closed to new investors, you will not be able
to purchase new shares of the fund in the future if you
draw your fund balance down to zero.
•
Any fees charged or expenses incurred in connection with
your instructions will be assessed at the “rep-assisted”
rates. Fees and expenses may be lower if you instead
place your trades online. Please refer to the Schedule of
Fees for more information.
1. Account Owner
Fidelity Account Number Name
Social Security or Taxpayer ID Number Daytime Phone Extension
2. Withdrawal Request
If this form directs Fidelity to sell shares of any securities (including mutual funds), be aware that:
• The timing of the transaction (i.e., when
your trade is processed) depends on
when we receive this form, which is
outside of your control.
• If you want to better control the timing
of the transaction, you should direct the
sale of securities online or through a
Fidelity representative.
• If you withdraw all assets from your
source account, that account will be
closed.
• Once we receive this form in good order,
you cannot cancel your distribution
request.
Cash Withdrawals from a Brokerage Account
For any withdrawal that involves the sale of mutual fund shares (other than money market funds) or other securities, skip to “All Other
Types of Withdrawals.”
ALL core cash and Fidelity money market funds in your brokerage account
Skip to Section 3.
ONLY the following amount of cash in your brokerage account:
Dollar Amount
Skip to Section 3.
$
.
This phone number
may be used if we have
questions, but will not
be used to update your
account information.
If the amount you
indicate is greater
than your core
account balance,
your request will
be denied.
1.741278.118 009200901
Withdrawal Request continues on next page.
Print
Reset
Save
Page 2 of 51.741278.118 009200902
All Other Types of Withdrawals
Trades may take up to five business days to process once determined to be in good order. Certain securities may not be eligible to sell via
this form. Examples of ineligible securities include options, certain fixed income securities, and thinly traded securities. To avoid any possible
delays, consider liquidating the positions either online or through a Fidelity representative prior to submitting this form.
In the event that transactions cannot be processed within five business days of determining your request to be in good order, Fidelity
will notify you and you may have to resubmit your request on the unsold positions within your account.
ENTIRE VALUE of your account in cash (all eligible securities will be sold)
ONLY the following eligible securities and amounts (securities indicated will be sold):
Security Name or Symbol
ALL
shares
ONLY
this many
shares:
Number of Shares
ONLY this
dollar amount:
Mutual Funds only.
Dollar Amount
.
$
.
Security Name or Symbol
ALL
shares
ONLY
this many
shares:
Number of Shares
ONLY this
dollar amount:
Mutual Funds only.
Dollar Amount
.
$
.
3. Withdrawal Method
You must obtain a Medallion signature guarantee in Section 4 if establishing standing bank wire instructions or requesting a one-time bank
wire with no standing instructions on file (previous one-time wire distributions do not indicate instructions have been added to your account); if
sending a check to a payee other than the account owner or to an alternate address; if the requested payment amount is over $100,000; or if
the address on the account has been changed within the past 10 days.
Electronic funds transfer (EFT) to a bank or credit union account using EFT instructions already in place on the
account. This form cannot be used to set up EFT. To add EFT to an account, go to Fidelity.com/eft or complete the
Electronic Funds Transfer (EFT) Authorization form.
A. EFT to your bank account. The name(s) on the bank account and the Fidelity account is (are) the same.
B. EFT to someone else. (Available for brokerage accounts only.) The names on the bank account and the
Fidelity account are different.
If EFT has not been established prior to the receipt of this request, a check will be mailed to the address
of record.
Bank Account Number
Check mailed to the address of record
Default if no choice indicated or if you did indicate a choice but we are unable
to process it. To confirm the address, go to Fidelity.com/address.
Check paid to a payee other than the account owner or mailed to an alternate address:
Payee Name
For Benefit of/Attention Address
City State/Province ZIP/Postal Code
Check one.
Provide bank information
ONLY if there are
multiple EFT instructions
on the account identified
in Section 1.
2. Withdrawal Request, continued
Withdrawal Method continues on next page.
1.741278.118 Page 3 of 5 009200903
Bank wire to a bank or credit union account in your name or someone else’s (cash only): To add standing
bank wire instructions to your account, you must check the box below and provide your bank information, or go
to Fidelity.com/movemoney.
Ask the bank for its wire routing number. The bank may charge for receipt of the wire. Additionally, if your transaction is an
international wire subject to Part B of the Electronic Funds Transfer Act (a “Remittance Transfer”), the completion of this form
is an indication of interest in this transaction. The transaction cannot be completed until you consent to prepayment disclosure
provided to you by telephone. The transaction may be routed through a different intermediary bank.
Establish the bank wire instructions listed below as standing instructions for the account referenced in
Section 1. ALL businesses and entities must also complete Section 5 if checking this box.
Wire Recipient
Bank Routing /ABA Number Bank Name
Account Number Account Owner Name(s) Required
Address of Wire Recipient FULL address is required for international wires.
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. Signature and Date Form cannot be processed without signature(s) and date(s). ONLY if establishing
standing bank wire instructions in Section 3, ALL businesses and entities must also review Section 5.
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 and request Fidelity to withdraw the
amount indicated in this form.
• Acknowledge that Fidelity is not responsible
for changes in the value of assets that may
occur during the withdrawal process.
• Accept all terms and conditions described in
this form.
• Certify that all information you provided is true,
accurate, and complete.
• Agree, if you are a trustee or a custodian, that
you are responsible for complying with your
legal and fiduciary obligations.
• Understand that Fidelity reserves the right, but
not the obligation, to confirm your instructions
with you prior to acting on the instructions or
indication of interest, as the case may be.
• Authorize Fidelity, in accordance with your
instructions, to wire the specified amount
payable to the account named above.
Additionally, if your transaction is a Remittance
Transfer, the completion of this form is an
indication of interest in this transaction. The
transaction contemplated herein cannot be
completed until you consent to the prepay-
ment disclosure provided to you by telephone.
• Agree to indemnify and hold us harmless from
any and all losses, costs, claims, or financial
obligations that may arise from any act or
omission of you with respect to your account
and from any and all losses, costs, claims, or
financial obligations that may arise from acting
upon the instructions provided herein.
If you ALREADY have
standing bank wire
instructions established
for the account referenced
in Section 1, check the
box and skip to Section 4.
Otherwise, provide
all requested bank
information. Note: Previous
one-time distributions do
not indicate instructions
have been added to
your account.
Unless these instructions
were already established
prior to this request, ALL
bank wire requests MUST
have a Medallion signature
guarantee. A notary seal/
stamp is NOT a Medallion
signature guarantee.
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.
3. Withdrawal Method, continued
Signature and Date continues on next page.
1.741278.118 Page 4 of 5 009200904
Customers requesting EFT:
• Authorize and request Fidelity to make EFT
withdrawals from the account listed in this form
by initiating debit entries to the account indi-
cated on this form.
• Authorize and request the specified bank to
accept such entries from Fidelity upon the sub-
mission of this form.
Customers establishing standing bank wire:
• 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.
Customers requesting trade processing:
• Authorize Fidelity to process trades on
your behalf.
• Acknowledge that you are delegating to
Fidelity the discretion to determine the price
and time at which certain securities should be
sold pursuant to your instructions contained in
this form.
• Acknowledge that trades may take up to five
business days to process once the request is
received and determined to be in good order,
and that your authorization shall remain in
effect during the entire period.
• Acknowledge that certain securities cannot be
sold through this form and may require you to
call a representative or go online to process
the trades.
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.
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:
•
if establishing standing bank wire instructions.
•
if requesting a one-time bank wire with no standing instructions on file (previous one-time wire distributions do not indicate instructions have been
added to your account).
•
if the check is being sent to an alternate address or payee.
•
if the address on the account has been changed within the past 10 days.
•
if the transaction is greater than $100,000.
If the form is completed at a Fidelity Investor Center with all signers present, 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 NAME
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
PRINT ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
4. Signature and Date, continued
Form continues on next page.
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 462946.11.0 (05/20)
Did you sign the form? Send the ENTIRE form
to Fidelity Investments.
Questions? Go to Fidelity.com/movemoney
or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0035
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
1.741278.118 Page 5 of 5 009200905
5. Business/Entity Account Certification ONLY if establishing standing bank wire instructions in
Section 3, ALL businesses and entities must review this section.
If a business or entity has only one officer and is requesting to establish standing bank wire instructions, that
officer must sign in Section 4. If there is more than one officer, an authorized individual other than those signing
in Section 4 must also sign below in this Section 5.
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.
If the form is completed at a Fidelity Investor Center with all signers present, 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
Questions? Go to Fidelity.com/security/overview or call 800-343-3548.
Let’s Talk about Protecting Your Money
A wire transfer is an easy, convenient way to send money to people you know. If you provide your information or send money to a scammer,
though, there is often little we can do to help get your money back. Here are some examples of common scams, things to ask yourself
before sending any funds, and what to do next if faced with one of these scams. Remember, in EVERY scenario, the first step is to STOP
communicating with the person immediately!
Romance Scam
What is it? A romance scam is a fraudulent scheme in which a fraudster pretends romantic interest in a target, establishes a relationship,
and then attempts to get money or personal sensitive information from the target under false pretenses.
What to do next if you suspect you’re a victim:
• Talk to someone you trust about your new relationship.
• Do a reverse image search of the person’s picture to see if it’s associated with another name or if the details don’t match.
Grandparent Scam
What is it? A scammer calls or emails you, posing as either a relative in distress or someone claiming to represent the relative (such as a
lawyer or law enforcement agent). The caller explains that the “relative” is in trouble and needs them to wire funds “immediately” for bail
money, lawyer’s fees, hospital bills, or another fictitious expense.
What to do next if you suspect you’re a victim:
• Call the relative (or their parent) directly, at their known phone number.
• If told you have to act quickly, resist that urge.
• Verify, verify, verify!
Sweepstakes/Inheritance Scam
What is it? You receive a notice stating that you’ve won a “big prize” or have received an unexpected inheritance. You’re told that in order
to claim the “prize” or “inheritance,” you need to send funds to cover “processing fees” or “taxes.” Once the money is sent, you never see
your prize or inheritance.
What to do next if you suspect you’re a victim:
• Independently verify the information by consulting reputable resources. Do not rely on resources the scammer gives you, since they are
probably involved in the scam as well.
• Remember, you cannot win a sweepstakes you never entered!
Investment Scam
What is it? An investment scam involves the illegal or purported sale of a financial instrument. The typical investment scam is characterized
by offers of low or no-risk investments, guaranteed returns, etc.
What to do next if you suspect you’re a victim:
• Don’t trust a person or company just because they have a website; a convincing website can be set up quickly.
• Be cautious when responding to special investment offers, especially through unsolicited email.
• Check with other resources regarding this person or company, and inquire about all the terms and conditions.
Watch for red flags Here are some examples of red flags that should make you think twice before sending money.
• A person or company solicits business from you rather than your finding them on your own.
• The requestor asks you to send the wire to a name different from their own.
• After just a few contacts, they profess strong feelings for you and ask to chat with you.
• They threaten legal action if the funds are not sent “right away.”
• The wiring instructions seem unusual, they change, or you’re asked to go to a different financial institution.
• You are coached on how to respond to questions your financial institution might ask you regarding the transaction.
• If you met on a dating site, they will try and move you away from the site and communicate via chat or email instead.
• Messages may be full of typing errors, poorly written, or vague, and may escalate quickly if you show resistance.
• The messages or calls become more desperate and/or persistent, and if you do send money, they ask you to send more.
Remember, if it seems too good to be true, it probably is!
Your security is our top priority. We’re here to help. If you have any concerns or want to know more about how to help protect yourself, talk to a
Fidelity representative or visit Fidelity’s Security Center online at Fidelity.com/security/overview. 928234.1.0 (05/20)
Page 1 of 11.9899061.100
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