Questions? Go to Fidelity.com/TransferMoneyShares or call 800-343-3548.
1.760007.110 Page 1 of 3 009220401
Transfer Between Existing Fidelity Accounts
Use this form to transfer assets between Fidelity accounts. Do NOT use this form to change the registration of an existing account.
Instead, go to Fidelity.com/forms for 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
This form isn’t right for all transfers! Call Fidelity if you are:
– transferring from another firm or workplace plan
transferring from a retirement account to a nonretirement
account (reportable distribution)
converting to a Roth IRA
initiating a direct rollover between a retirement plan and an IRA
transferring between retirement accounts and there is ANY
difference in how the names appear on the accounts
Any transfer from a nonretirement account to an IRA will
be considered a contribution and is subject to annual IRA
contribution limits, unless specifically designated as a 60-Day
Rollover in Section 4.
For brokerage accounts, please note that:
Any cash transfers OUT of a brokerage account will be
taken from the core position. If the amount you indicate is
greater than your core position balance, we will be unable
to process your request. You can direct the sale of securities
online or through a Fidelity representative, allowing at least
two (2) business days for trade settlement before submitting
this form.
Any cash transfers INTO a brokerage account will be
deposited into the core position, unless you choose the
“Transfer the following securities in kind” option in Section 3.
For Mutual Fund Only accounts (account begins with a 2,
followed by two letters), please note that:
If this form directs Fidelity to sell mutual fund shares in
the transferring Mutual Fund Only account and/or to
purchase mutual fund shares in the receiving Mutual Fund
Only account (i.e., you are not choosing the “Transfer the
following securities in kind” option in Section 3), be aware
that the timing of the transaction depends on when we
receive this form in good order, which is outside of your
control. To better control the timing of the transaction,
you should instead place your trades online or through a
Fidelity representative.
Sales or purchases of a mutual fund 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 applicable fund
prospectus for more information.
Once we receive this form in good order, you cannot cancel
your request.
1. Transfer OUT OF This Fidelity Account
Account Number Fidelity Fund Name or Symbol Mutual fund accounts ONLY (Account begins with a 2, followed by two letters.)
Owner Name(s), Company, or Trust Name
Daytime Phone Extension
2. Transfer INTO This Fidelity Account
Account Number Fidelity Fund Name or Symbol To Purchase Mutual fund accounts ONLY (Account begins with a 2, followed by
two letters.)
Owner Name(s), Company, or Trust Name
Provide the name(s) on
transferring account.
This phone number
may be used if we
have questions, but
will not be used to
update your account
information.
Provide the name(s) on
receiving account.
Form continues on next page.
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1.760007.110 Page 2 of 3 009220402
3. Transfer Amount
FULL transfer of the entire account. Your account will be closed, unless you tell us otherwise by checking the
box below. If transferring from a brokerage account into a Mutual Fund Only account (account begins with a 2,
followed by two letters), only Fidelity mutual funds are eligible to be transferred in kind. All other securities will
remain in the original account.
Skip to Section 4.
Do NOT close the account.
ONLY the following amount of cash from your brokerage account. If the amount you indicate is greater than your core
position balance, we will be unable to process your request. You can direct the sale of securities online or through a
Fidelity representative, allowing at least two (2) business days for trade settlement before submitting this form.
Entire core balance.
Specified amount:
Dollar Amount
$
.
Transfer the following securities in kind. If transferring from a brokerage account into a Mutual Fund Only
account (account begins with a 2, followed by two letters), only Fidelity mutual funds are eligible to be
transferred in kind. All other securities will remain in the original account.
Investment Name CUSIP or Symbol Number of Shares/ALL
ALL
.
Lot Acquisition Date MM DD YYYY Lot Acquisition Cost
$
.
Investment Name CUSIP or Symbol Number of Shares/ALL
ALL
.
Lot Acquisition Date MM DD YYYY Lot Acquisition Cost
$
.
Investment Name CUSIP or Symbol Number of Shares/ALL
ALL
.
Lot Acquisition Date MM DD YYYY Lot Acquisition Cost
$
.
4. Reason for Transfer
Transfer from a nonretirement account to an IRA. You must indicate below if this is an annual IRA contribution or
a 60-Day Rollover.
Traditional, Roth, or SEP IRA annual contribution. All contributions must be made in cash.
Contribution Year YYYY
Traditional or Roth IRA contributions will be coded as current year, unless specified otherwise.
Prior year contributions received after the tax-filing deadline will be coded as current year.
60-Day Rollover. All rollovers must be made as cash.
Transfer from a nonretirement account to a nonretirement account. Transfers between accounts with different
tax identification numbers will be coded as a gift, unless you select Non-Gift below and provide a brief
explanation below.
Gift
Non-Gift
Reason for Non-Gift Transfer
Transfer from an IRA to an IRA that are like registrations to consolidate accounts (e.g., Traditional IRA to
Traditional IRA). Your name and SSN must be identical on both accounts. Note: This does not include
conversions to Roth IRAs or rollovers between retirement plans and IRAs.
Check ONLY one and
provide any additional
required information.
Indicate the number of
shares or check “All.”
Enter specific share
identification, if
applicable. You must
provide the lot acquisi-
tion date for specific
share instruction on or
before the date of the
transfer (gift/journal)
taking place. For mul-
tiple lots, list each lot
on a separate line.
To list more securities,
make a copy of this
page or attach a sepa-
rate sheet, including
the same information.
The attachment must
be signed and dated.
Check ONLY one and
provide any additional
required information.
“Gift” is the default if
nothing is selected.
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. 432196.5.0 (05/19)
1.760007.110 Page 3 of 3 009220403
5. Signature(s) and Date(s) Account owner(s) of the transferring account must sign and date.
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC and National Financial Services and their affiliates,
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; 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:
Direct Fidelity to act on all instructions given
on this form and agree to indemnify us
(jointly and severally, for accounts with more
than one owner) from and hold us harmless
for any and all losses, liabilities, claims, and
costs (including reasonable attorneys’ fees)
resulting from our effecting any transaction
or acting upon such instructions.
Indemnify Fidelity from any and all
liability in the event you fail to meet any
IRA requirements concerning your IRA(s)
referred to in this form, as applicable.
One authorized signature is required unless you have a Mutual Fund Only Account (the account number begins with a 2 followed by
two letters), in which case all owners of the transferring account must sign.
A Medallion signature guarantee is required if:
the receiving account has a different owner (owner names on the two accounts do not match for example, an individual to a different individual)
AND
the value of the transfer is greater than $10,000.
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
signature guarantee.
PRINT OWNER NAME
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
X
PRINT OWNER NAME
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
X
Did you print and sign the form? Send the ENTIRE form
to Fidelity Investments.
Questions? Go to Fidelity.com/TransferMoneyShares
or call 800-343-3548.
Use postage-paid envelope OR deliver to:
Regular mail
Fidelity Investments
Attention: Distribution Services
PO Box 770001
Cincinnati, OH 45277-0035
Overnight mail
Fidelity Investments
Attention: Distribution Services
100 Crosby Parkway
Mailzone: KC1D
Covington, KY 41015-4325