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Questions? Go to Fidelity.com/college or call 800-544-1914.
Withdrawals 529 College Savings Plan
Use this form to make a one-time withdrawal (either full or partial) from a 529 College Savings Plan. Do NOT use this form to
transfer assets to another beneficiary. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room
for information, make a copy of the relevant page.
Helpful to Know
It is your responsibility to ensure that your withdrawals
comply with IRS requirements. Non-qualified withdrawals
could trigger IRS fees or penalties. At the end of each
tax year, Fidelity will send a 1099-Q to the IRS, and to
the participant or beneficiary, reporting any withdrawals.
You may want to consult a tax advisor.
If a 529 plan account was established under the Uniform
Gifts to Minors Act or Uniform Transfers to Minors Act
(UGMA/UTMA), the account assets belong to the minor/
beneficiary and may only be used for the benefit of the
minor/beneficiary.
If you are making withdrawals from more than one
529 plan, you must complete a separate withdrawal
form for each account.
Be aware that the value of your account could change
between the time you place your withdrawal request and
the time it is processed.
1. Participant (Owner) / Authorized Individual
Name / Trust Name Social Security or Taxpayer ID Number
Daytime Phone Extension
2. Beneficiary Student Information
Name Social Security or Taxpayer ID Number
3. Account Number and Request Reason
Account Number
Request Reason
Qualified: To pay beneficiary’s qualified higher education expenses
Non-Qualified: Other
Account Status if Balance Goes to Zero
Close account
Leave account open for possible future contributions Default if no choice indicated.
This phone number will
be used if we have
questions, but will not
update your Fidelity
contact information.
If your distribution
request brings your
total balance to zero,
indicate what you
would like us to do.
1.933233.105 015390501
Form continues on next page.
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Reset
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4. Distribution Amount
ALL assets in this account.
Default if no other information indicated below. Skip to Section 5.
ONLY the following amount(s) from the following portfolio(s).
Portfolio Dollar Amount
or ALL
$
Portfolio Dollar Amount
or ALL
$
Portfolio Dollar Amount
or ALL
$
Total of Dollar Amounts
$
Reserve Portfolio
5. Distribution Method
You must obtain a Medallion signature guarantee in Section 6 if requesting a bank wire, if sending a distribution over $10,000 to an alternate
payee or address (other than a college/university), if the requested payment amount is over $100,000, or if the address on the account has
been changed within the past 10 days.
Check Payment
Check paid to the participant and 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 address, go to Fidelity.com/address.
Check paid to an eligible educational institution, a beneficiary, or the participant and mailed to an alternate
address, or to any payee other than the participant.
Alternate Payee / Institution Name Student ID Required
Address
City State/Province ZIP/Postal Code Country
Rollover check payable to the following company and plan:
Company / Plan Name Account / Plan Number
Address
City State/Province ZIP/Postal Code Country
Transfer
Transfer to a Fidelity nonretirement account:
Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol Mutual fund accounts ONLY
Indicate at least one
portfolio name. If the
amount of your request
is equal to or greater
than your portfolio
value, we will send only
the available balance.
Use this to indicate a
portfolio we can draw
from if one or more of
the above portfolios
does not contain the
dollar amount you have
requested on the day we
process your withdrawal.
Check ONLY one and
provide any required
information.
Distribution Method continues on next page.
0.00
1.933233.105 Page 3 of 4 015390503
Electronic Payment
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
Bank Wire
Bank wire to a bank or credit union account in your name or someone else’s. The bank may charge a fee for
wire transfers.
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
6. Signature and Date Participant / Authorized Individual must sign and date.
By signing below, you:
Authorize and request Fidelity to withdraw
the amount indicated on this form.
Understand that if this 529 plan account
was established as an UGMA / UTMA 529
account, the account assets belong to the
minor / beneficiary and may only be used
for the benefit of the minor / beneficiary.
Accept that Fidelity is not responsible for
changes in the value of assets that may
occur during the distribution process.
Certify that all information provided in this
form is true, accurate, and complete.
Indemnify the plan and Fidelity, its agents,
successors, affiliates, and employees from
any liability in the event that you fail to
meet the IRS requirements.
Indemnify the plan and Fidelity, its agents,
successors, affiliates, and employees from
any liability related to this withdrawal.
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 indicated on this form.
Authorize and request the bank named in
Section 5 of this form, or the bank specified
in your existing instructions, to accept debit
entries initiated by Fidelity in such account
and to debit the same account without
responsibility for the appropriateness or for
the existence of any further authorization.
Acknowledge that you have read and
agree to the Important Information about
Electronic Funds Transfer (“EFT”) docu-
ment, if you have elected to use EFT.
Acknowledge that you have read, under-
stand, and agree to the terms and
conditions set forth in the separate Fact
Kit as is currently and as may be amended
from time to time.
Provide bank informa-
tion ONLY if there are
multiple EFT instruc-
tions on the account
identified in Section 3.
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.
5. Distribution Method, continued
Signature and Date continues on next page.
1.933233.105 Page 4 of 4 015390504
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 595922.6.0 (05/20)
Did you sign the form? Send the ENTIRE form to Fidelity Investments.
Questions? Go to Fidelity.com/college or call 800-544-1914.
Regular mail
Fidelity Investments
Attn: CPSC
PO Box 770001
Cincinnati, OH 45277-0015
Overnight mail
Fidelity Investments
Attn: CPSC
100 Crosby Parkway KC1K
Covington, KY 41015
A Medallion signature guarantee is required if:
• Requesting a bank wire
• The transaction is over $100,000
• The address on the account has been changed within the past 10 days
• Sending a distribution of $10,000 or more to an alternate payee or address (other than a college/university)
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 PARTICIPANT/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
PARTICIPANT/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
6. Signature and Date, continued
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)
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