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Fidelity Growth and Guaranteed Income Partial Withdrawal/Full Surrender Form, page 1
Basic · 40/100Form Complexity Index

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What this form asks for

The AI fills all of it, from your answers or your documents.

This form is used by owners of a Fidelity Growth and Guaranteed Income contract to request either a partial withdrawal of funds or a full surrender of their annuity. It allows the contract owner to specify the amount, provide tax withholding instructions, and direct how the payment should be received. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields55
Pages3
Form Complexity IndexBasic, 40/100

The AI checks your answers before you download

14 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Exclusive Withdrawal or Surrender Request

Validates that the user has completed either Section 2 for a partial withdrawal or Section 3 for a full surrender, but not both. This is crucial for preventing ambiguous or conflicting instructions that would require manual intervention to resolve. If both sections are filled, the form submission should be rejected with an error message prompting the user to choose only one action.

Contract Number and Owner Verification

Ensures the provided Contract Number exists, is active, and that the Owner's Name in Section 1 matches the primary owner on record for that contract. This is a fundamental security check to prevent unauthorized access to or transactions on an annuity. A mismatch would block the request and may trigger a fraud alert.

Partial Withdrawal Minimum Amount

Checks that if a 'Partial Withdrawal - Gross' or 'Partial Withdrawal - Net Charges' is requested, the specified dollar amount is a numeric value greater than or equal to the stated $50 minimum. This rule enforces the contract's terms and prevents the processing of insignificant or invalid transaction amounts. Requests below the minimum will be rejected, requiring the user to correct the amount.

Partial Withdrawal Option Selection

Verifies that in Section 2, exactly one withdrawal option ('Gross', 'Net', or 'Annual Maximum GWB') has been selected. If a gross or net amount is chosen, this check also ensures a corresponding dollar value has been entered. This prevents incomplete requests and ensures the withdrawal calculation method is clearly defined.

Full Surrender Certification Requirement

If a full surrender is requested in Section 3, this check ensures one of the two certification boxes regarding the original contract's status (enclosed or lost/destroyed) is checked. This certification is a required part of the legal process for closing the contract. An incomplete certification would prevent the surrender from being processed.

Required Tax Withholding Election

Verifies that a mandatory choice has been made in Section 4 regarding federal tax withholding. The user must explicitly select either to withhold a specific percentage or not to withhold taxes at all. This ensures compliance and clarity on tax handling, preventing the system from using a default that the client may not want.

And 8 more checks
  • Valid Tax Withholding Percentage
  • Singular Payment Method Selection
  • Conditional Third-Party Payee Information
  • Conditional Fidelity Account Number
  • Required Owner Signature and Date
  • Conditional Joint Owner Signature
  • Signature Guarantee Requirement Logic
  • Valid Phone Number Format

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How to Fill Out Fidelity Partial Withdrawal/Full Surrender Form Online for Free in 2026

What the AI walks you through.

  1. Navigate to Instafill.ai and upload or select the Fidelity Partial Withdrawal/Full Surrender Form.
  2. Use the AI assistant to accurately fill in your contract owner information, including name, contract number, and phone number in Section 1.
  3. Choose your request type: either a partial withdrawal in Section 2, specifying the amount and source, or a full surrender in Section 3.
  4. Complete Section 4 to provide your federal income tax withholding instructions for the distribution.
  5. Indicate your preferred payment method in Section 5, such as a check to your address of record or an electronic funds transfer (EFT).
  6. Carefully review all the information you've entered for accuracy before proceeding.
  7. Electronically sign the form in Section 6. The system will alert you if a signature guarantee is required based on your request, which must be obtained separately before mailing the form.

Common Mistakes in Completing Fidelity Partial Withdrawal/Full Surrender Form

The ones the AI is built to catch.

Failing to Obtain a Signature Guarantee When Required
Users often misunderstand or overlook the Signature Guarantee requirement, mistaking it for a notary public stamp. This form requires a Signature Guarantee for withdrawals over $100,000, payments to third parties, or payments to a new address. Submitting without the correct stamp from an eligible financial institution will lead to immediate rejection and significant processing delays. To avoid this, carefully review the criteria in Section 6 and visit a bank or broker to obtain the guarantee before mailing the form.
Missing Joint Owner's Signature
On jointly owned contracts, it is common for only one owner to sign the form. The instructions in Section 6 clearly state that signatures of all owners are required in every case. An application with a missing signature is considered incomplete and will be returned, delaying the withdrawal or surrender process. Always ensure all individuals listed as owners on the contract have signed and dated the form in the designated spaces.
Confusing 'Gross' and 'Net' Partial Withdrawals
In Section 2, people often misunderstand the difference between a 'Gross' and 'Net' withdrawal. Requesting a 'Gross' amount means taxes and fees will be deducted from that amount, resulting in a smaller check. Requesting a 'Net' amount means the firm will withdraw enough to cover the requested amount plus any fees, so the check matches the request. This confusion can lead to receiving an unexpected payment amount. Carefully read the descriptions to ensure the withdrawal meets your financial needs.
Incomplete Tax Withholding Instructions
A frequent error in Section 4 is checking the box 'I WANT Federal Income Tax withheld' but failing to write in a specific percentage. This ambiguity forces the processing agent to either use the 10% default or return the form for clarification, causing delays. To prevent this, if you elect to have taxes withheld, always specify a whole number percentage in the space provided. If you do not want taxes withheld, be sure to check the 'I DO NOT want' box.
Submitting Contradictory Requests
Applicants sometimes fill out both Section 2 for a partial withdrawal and Section 3 for a full surrender. The form's instructions direct the user to fill out one or the other, not both. Submitting a form with conflicting instructions makes the user's intent unclear and will halt the processing of the request until clarification is obtained. Decide on one course of action and complete only the relevant section to ensure your request is processed correctly.
Incorrect or Incomplete Contract Number
The contract number is the primary identifier for the account, and data entry errors like transposing digits or omitting a number are common. An incorrect contract number in Section 1 will prevent Fidelity from locating the account, causing the request to be rejected. Double-check the contract number against your account statement to ensure it is completely accurate before submitting. AI-powered tools like Instafill.ai can help prevent this by saving and accurately populating such critical information.
Mailing the Form to the Wrong Address
The form lists two different P.O. Box addresses at the bottom: one for New York residents and one for all other states. Sending the form to the incorrect address can add significant delays as it will need to be rerouted internally. To avoid this, New York residents must use the specific 'Empire Fidelity' P.O. Box, while all other residents should use the standard 'Fidelity Investments' P.O. Box.
Attempting to Fax the Form
Despite advances in technology, many people still attempt to fax forms out of habit. The instructions at the top of this form explicitly state 'Faxes are not accepted.' Any request submitted via fax will be disregarded, and the user will not receive their funds or any notification of the failed submission. The only valid submission method is mailing the physical form to the correct address. Since this is a non-fillable PDF, tools like Instafill.ai can convert it into a fillable version for clean, legible printing before mailing.
Invalid Payment Instructions
In Section 5, users may request a payment method that triggers an additional requirement they fail to meet. For example, requesting a check be mailed to an address other than the one on record requires a Signature Guarantee. Failing to provide that guarantee will cause the request to be rejected. To avoid this, either use a payment method that doesn't require a guarantee (like a check to the address of record) or ensure you complete all associated requirements for your chosen method.
Mismatch Between Total and Itemized Withdrawal Amounts
When requesting a partial withdrawal from specific funds in Section 2, users sometimes list individual fund amounts that do not add up to the 'Total Amount' they entered. This discrepancy creates ambiguity and requires the service center to contact the owner for clarification, delaying the transaction. If you choose to specify withdrawals from particular funds, always double-check your math to ensure the sum of the parts equals the requested total.

Frequently Asked Questions About Fidelity Partial Withdrawal/Full Surrender Form

 

Is it really free for 7 days?
Yes. You pay $0 today. Cancel before Nov 1 and you are never charged. Keep it, and it is $19.99 a month for 5 fills of your Fidelity Partial Withdrawal/Full Surrender Form.
Can I fill other forms too?
This plan is for your Fidelity Partial Withdrawal/Full Surrender Form: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
How do I cancel?
From your account, in two clicks, any time. No email, no call.
How does the AI fill out Fidelity Partial Withdrawal/Full Surrender Form?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of Fidelity Partial Withdrawal/Full Surrender Form, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is Fidelity Partial Withdrawal/Full Surrender Form to fill out?
Fidelity Partial Withdrawal/Full Surrender Form has a Form Complexity Index of 40 out of 100, in the basic tier: 55 fillable fields across 3 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of this form?
This form is used to request either a partial withdrawal of funds or a full surrender (cancellation) of your Fidelity Growth and Guaranteed Income annuity contract.
Who needs to fill out this form?
The owner(s) of a Fidelity Growth and Guaranteed Income annuity contract who wish to access their funds should complete this form.
What is the difference between a partial withdrawal and a full surrender?
A partial withdrawal allows you to take out some money while keeping your contract active. A full surrender terminates your contract completely, and you receive the entire cash value, minus any applicable fees and taxes.
What happens if I don't specify my tax withholding preference in Section 4?
If you do not make a selection for tax withholding, Fidelity will automatically deduct 10% for Federal Income Tax from the taxable portion of your distribution.
How do I submit the completed form?
You must mail the completed and signed form to the P.O. Box address provided at the bottom of the form. Please note that faxes are not accepted.
Are there penalties for taking a withdrawal before age 59 ½?
Yes, taxable amounts withdrawn before you reach age 59 ½ may be subject to a 10% IRS penalty. Withdrawals may also reduce your guaranteed withdrawal benefit (GWB) and be subject to a surrender fee.
What are my options for receiving the payment?
You can choose to receive a check by mail, have the funds transferred electronically (EFT) to your bank on record, or transfer the proceeds to another non-retirement Fidelity account.
What is a Signature Guarantee and when is it required?
A Signature Guarantee protects against fraud and is required for withdrawals over $100,000, payments to a third party, or payments sent to an address not on record. It is different from a notarization and can be obtained from most banks or brokerage firms.
What happens to my Systematic Withdrawal Program (SWP) if I request a partial withdrawal?
Requesting a partial withdrawal with this form will terminate your active SWP. You will need to reinstate it during the next contract year if you wish for it to continue.
For a full surrender, do I need to send my original contract document?
Yes, you should either enclose the original contract with the form or, if it has been lost or destroyed, check the box in Section 3 to certify this.
Can I use an AI tool to help me fill out this form?
Yes, services like Instafill.ai use AI to accurately auto-fill form fields with your information, which can save you time and help reduce errors.
How can I fill out this form online?
You can use a service like Instafill.ai to complete this form online. Simply upload the PDF, and the tool will make the fields interactive for you to fill out and sign electronically.
What should I do if my PDF of this form is not fillable?
If you have a non-fillable PDF, you can upload it to a platform like Instafill.ai. The service can convert flat PDFs into interactive, fillable forms that you can easily complete on your computer.
Who can I call if I have questions about filling out this form?
If you have questions, you can call the Annuity Service Center at 800-634-9361 from Monday through Friday, 8 a.m. to 8 p.m. Eastern Time.
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