Fidelity Advisor Name Change Authorization Form Instructions
This form contains 21 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Account Owner Signature | ||
| Account Owner Printed Name | Text |
Enter the full printed name of the account owner, including first name, middle initial, and last name.
|
| Account Owner Signature Date | Date |
Provide the date the account owner signed this form.
|
| Contact Information | ||
| Primary Mobile Phone Number | Text |
Please enter the primary mobile phone number used to verify and/or authorize transactions.
|
| Email Address | Text |
Please enter your email address.
|
| Former Name and SSN | ||
| Former First Name | Text |
Enter the former first name of the account owner.
|
| Former Middle Initial | Text |
Enter the former middle initial of the account owner.
|
| Former Last Name | Text |
Enter the former last name of the account owner.
|
| Former SSN | Text |
Enter the former Social Security Number of the account owner.
|
| General | ||
| Button | ||
| Reset | Button | |
| New Name and Account Number | ||
| New First Name | Text |
Enter the new first name of the account owner.
|
| New Middle Initial | Text |
Enter the new middle initial of the account owner, if applicable.
|
| New Last Name | Text |
Enter the new last name of the account owner.
|
| Fidelity Account Number | Text |
Enter the Fidelity account number for which the name change applies.
|
| Notary Public Information | ||
| Notary State | Text |
Provide the state where the notarization is being performed.
|
| Notary County | Text |
Provide the county where the notarization is being performed.
|
| Notary Identification | Text |
Provide details of the identification used by the signer.
|
| Printed Notary Name | Text |
Provide the full printed name of the Notary Public.
|
| Commission Expiration Date | Date |
Provide the date when the notary public's commission expires.
|
| Notary Signature Date | Date |
Provide the date the notary public signed the document.
|
| Reason for Name Change | ||
| Reason for Name Change | Text |
Enter the reason for the name change, such as marriage, divorce, or other circumstances.
|