Fidelity Advisor Transfer Due to Divorce—IRA Form Instructions

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This form contains 36 fields organized into 11 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Fifth Fund Transfer Detail
Fifth Fund Number Text
Enter the fund number for the fifth fund transfer.
Max length: 4 characters
Fifth Fund Transfer Amount Dollars Number
Enter the whole dollar amount for the fifth fund transfer.
Max length: 6 characters
Fifth Fund Transfer Amount Cents Number
Enter the cents for the fifth fund transfer.
Max length: 2 characters
Fifth Fund Transfer Percentage Number
Enter the percentage for the fifth fund transfer.
Max length: 3 characters
First Fund Transfer Detail
First Fund Transfer Fund Number Text
Enter the fund number for the first fund being transferred.
Max length: 4 characters
First Fund Transfer Amount (Dollars) Number
Enter the dollar amount for the first fund being transferred before the decimal point.
Max length: 6 characters
First Fund Transfer Amount (Cents) Number
Enter the cents portion of the dollar amount for the first fund being transferred, after the decimal point.
Max length: 2 characters
First Fund Transfer Percentage Number
Enter the percentage of the first fund to be transferred.
Max length: 3 characters
Former Spouse Information
New Account Application Enclosed Checkbox
Check this box if a new account application for the former spouse is enclosed with this form.
Former Spouse Existing Account Number Text
Please enter the existing account number for the former spouse.
Max length: 11 characters
Former Spouse Shareholder Name Text
Please enter the full name of the former spouse as the shareholder.
Former Spouse Mobile Phone Number Text
Please enter the former spouse's mobile phone number, which will be used as their primary contact.
Max length: 10 characters
Former Spouse Email Address Text
Please enter the former spouse's email address.
Fourth Fund Transfer Detail
Fourth Fund Number Text
Enter the fund number for the fourth transfer.
Max length: 4 characters
Fourth Transfer Amount Dollars Number
Enter the whole dollar amount for the fourth transfer.
Max length: 6 characters
Fourth Transfer Amount Cents Text
Enter the cents portion of the dollar amount for the fourth transfer.
Max length: 2 characters
Fourth Transfer Percentage Number
Enter the percentage for the fourth transfer.
Max length: 3 characters
General
Print Button
Reset Button
IRA Owner Information
IRA Owner Account Number Text
Enter the account number for the IRA owner.
Max length: 11 characters
IRA Owner Shareholder Name Text
Enter the full name of the IRA shareholder.
IRA Owner Mobile Phone Number Text
Enter the primary mobile phone number for the IRA owner.
Max length: 10 characters
IRA Owner Email Address Text
Enter the email address for the IRA owner.
Legal Document Details
Legal Document Section or Page Text
Enter the section or page of the applicable legal document that references the account(s) being transferred.
Page 4
5a. IRA Owner Name Text
Enter the printed name of the IRA Owner who is the relinquishing party.
5b. Former Spouse Name Text
Enter the printed name of the Former Spouse who is the receiving party.
Second Fund Transfer Detail
Second Fund Number Text
Provide the fund number for this second transfer detail.
Max length: 4 characters
Second Transfer Amount Dollars Number
Enter the dollar amount for this second fund transfer detail.
Max length: 6 characters
Second Transfer Amount Cents Number
Enter the cents portion of the amount for this second fund transfer detail.
Max length: 2 characters
Second Transfer Percentage Number
Enter the percentage for this second fund transfer detail.
Max length: 3 characters
Third Fund Transfer Detail
Third Fund Transfer Fund Number Text
Provide the fund number for the third fund transfer detail.
Max length: 4 characters
Third Fund Transfer Amount (Dollars) Number
Enter the whole dollar amount for the third fund transfer.
Max length: 6 characters
Third Fund Transfer Amount (Cents) Number
Enter the cents portion of the dollar amount for the third fund transfer.
Max length: 2 characters
Third Fund Transfer Percentage Number
Enter the percentage value for the third fund transfer.
Max length: 3 characters
Transfer Type
Full Transfer Checkbox
Check this box if the entire account or asset is being transferred.
Partial Transfer Checkbox
Check this box if only a portion of the account or asset is being transferred, and complete the details below.