Fidelity ABLE Account Rollover/Transfer Request Form Completed Form Examples and Samples
Explore real-world examples of completed Fidelity ABLE Account Rollover/Transfer Request Forms. Our sample forms show step-by-step how to fill out beneficiary information, transfer details, rollover types, and authorized representative signatures — helping you avoid errors and submit your ABLE account transfer with confidence.
Fidelity ABLE Account Rollover/Transfer Request Form Example – Same Beneficiary Rollover
How this form was filled:
This example shows how a Fidelity ABLE Account Rollover/Transfer Request Form is filled out when an existing ABLE account beneficiary moves funds from an out-of-state ABLE program (Ohio STABLE Account) to a Fidelity ABLE account. The form captures the beneficiary's personal information, the current plan details, the receiving Fidelity ABLE account number, and the rollover amount, with the authorized representative's signature included.
Information used to fill out the document:
- Beneficiary First Name: Marcus
- Beneficiary Middle Initial: L
- Beneficiary Last Name: Whitfield
- Beneficiary Date of Birth: 03/14/1992
- Beneficiary Social Security Number (SSN): XXX-XX-4821
- Beneficiary Address: 417 Elmwood Drive, Columbus, OH 43215
- Beneficiary Phone Number: (614) 555-0193
- Transferring ABLE Plan Name: Ohio STABLE Account
- Transferring Plan Account Number: OH-STB-2019-884721
- Transferring Plan State: Ohio
- Transfer Type: Rollover (Same Beneficiary)
- Transfer Amount: Full Balance
- Estimated Transfer Amount: $18,450.00
- Receiving Fidelity ABLE Account Number: Z48-291837
- Authorized Representative Name: Diana R. Whitfield
- Relationship to Beneficiary: Parent / Legal Guardian
- Authorized Representative Phone: (614) 555-0174
- Signature: Diana R. Whitfield
- Date Signed: 02/10/2026
What this filled form sample shows:
- Correctly completed beneficiary personal information including name, date of birth, SSN, and address
- Accurately identified transferring ABLE plan with plan name, state, and account number
- Proper selection of rollover type as a same-beneficiary rollover from an out-of-state ABLE program
- Full balance transfer amount specified with estimated dollar value for processing
- Valid receiving Fidelity ABLE account number for the destination account
- Authorized representative details including relationship to beneficiary and contact information
- Properly formatted signature and date from the legal guardian acting on behalf of the beneficiary
Form specifications and details:
| Use Case: | Same-beneficiary ABLE account rollover from an out-of-state plan to Fidelity ABLE |
| Transferring Plan: | Ohio STABLE Account |
| Receiving Plan: | Fidelity ABLE Account |
| Rollover Type: | Same Beneficiary Rollover |
| Transfer Scope: | Full Balance |
| Beneficiary Relationship: | Adult beneficiary represented by a parent/legal guardian |
| Form Purpose: | Request transfer of ABLE account funds without tax penalty under IRS rollover rules |
| Applicable IRS Rule: | One rollover per 12-month period for same beneficiary |
| Disability Eligibility: | Beneficiary diagnosed with qualifying disability prior to age 26 |
| Form Completion Year: | 2026 |
Created: February 25, 2026 05:52 AM
