One-And-The-Same Letter
Use this form to notify Fidelity of any slight discrepancies in the way your name is listed on your Fidelity account and the account from
which your assets are being transferred. For complete name changes, such as due to marriage or divorce, complete the Name Change
form and include the appropriate legal documents such as a marriage certificate or divorce decree. Do NOT use this form for employer-
sponsored accounts. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room for information or
signatures, make a copy of the relevant page.
1. Account Owner
Name on Fidelity Account
First Name
Middle Name Last Name
Social Security or Taxpayer ID Number
Name on Account Being Transferred
First Name
Middle Name Last Name
2. Signature and Date Account owner must sign and date.
By signing below, you:
• Certify that the two names indicated above refer to one and the
same person.
• Authorize Fidelity to accept transactions under either name.
Name and Signature on Fidelity Account
PRINT OWNER NAME First, Middle, Last Name
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
Name and Signature on Account Being Transferred
PRINT OWNER NAME First, Middle, Last Name
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
Examples of
Alternate Name:
nickname; alternate
spelling; Jr./Sr.; or
use of initials.
Questions? Go to Fidelity.com or call 800-343-3548.
1.943139.104 Page 1 of 1 028860301
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 615791.4.0 (11/19)
Did you print and sign the form, and attach any necessary
documents? Send the form and any necessary documents to Fidelity.
Fidelity will send a confirmation to you.
Questions? Go to Fidelity.com 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
Enter full first and last
name as evidenced by
a government-issued,
unexpired document (e.g.,
driver’s license, passport,
permanent resident card).
