Fidelity Investment-Only (Non-Prototype) Retirement Account Application Instructions
This form contains 188 fields organized into 53 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Annual Income | ||
| Annual Income Under $20,000 | Checkbox |
Check this box if your annual income from all sources is less than $20,000.
|
| Annual Income $20,000-$50,000 | Checkbox |
Check this box if your annual income from all sources is between $20,000 and $50,000.
|
| Annual Income $50,001-$100,000 | Checkbox |
Check this box if your annual income from all sources is between $50,001 and $100,000.
|
| Annual Income Over $100,000 | Checkbox |
Check this box if your annual income from all sources is greater than $100,000.
|
| Associated Company Information | ||
| Associated Company Name | Text |
Enter the full legal name of the associated company.
|
| Associated Company Address Line 1 | Text |
Enter the street address of the associated company.
|
| Associated Company City | Text |
Enter the city of the associated company's address.
|
| Associated Company State/Province | Text |
Enter the state or province of the associated company's address.
|
| Associated Company ZIP/Postal Code | Text |
Enter the ZIP or postal code of the associated company's address.
|
| Associated Company Country | Text |
Enter the country of the associated company's address.
|
| Associated Company Name | Text |
Enter the full legal name of the associated company.
|
| Associated Company Address Line 1 | Text |
Enter the primary street address or post office box for the associated company.
|
| Associated Company City | Text |
Enter the city of the associated company's address.
|
| Associated Company State/Province | Text |
Enter the state or province of the associated company's address.
|
| Associated Company ZIP/Postal Code | Text |
Enter the ZIP or postal code of the associated company's address.
|
| Associated Company Country | Text |
Enter the country of the associated company's address.
|
| Checkwriting Option | ||
| Checkwriting Service | Checkbox |
Check this box if you want to enable the checkwriting service, allowing you to write checks on the cash in your core account.
|
| Citizenship Status | ||
| U.S. citizen | Checkbox |
Check this box if your citizenship status is U.S. citizen.
|
| Foreign citizen | Checkbox |
Check this box if your citizenship status is foreign citizen.
|
| U.S. citizen | Checkbox |
Check this box if you are a U.S. citizen.
|
| Foreign citizen | Checkbox |
Check this box if you are a foreign citizen.
|
| Contact Information | ||
| 5 | Text | |
| Secondary Phone Number | Text |
Enter a secondary phone number for the contact, if applicable.
|
| Email Address | Text |
Enter the email address for contact and communications.
|
| Country of Citizenship | ||
| Country of Citizenship | Text |
Enter the country of your citizenship.
|
| Country of Citizenship | Text |
Provide the country where the applicant holds citizenship.
|
| Date of Birth | ||
| Date of Birth | Date |
Provide the date of birth.
|
| Date Plan Established | ||
| Date Plan Established | Date |
Enter the date the plan was established.
|
| Employer Information | ||
| Employer's Name | Text |
Enter the full legal name of the employer.
|
| Employer's Address Line 1 | Text |
Enter the primary street address of the employer.
|
| Employer's City | Text |
Enter the city where the employer is located.
|
| Employer's State | Text |
Enter the state where the employer is located.
|
| Employer's ZIP Code | Text |
Enter the ZIP or postal code for the employer's address.
|
| Employer's Address | ||
| Employer's Address Street | Text |
Enter the street address of the employer.
|
| Employer's Address City | Text |
Enter the city of the employer's address.
|
| Employer's Address State | Text |
Enter the state of the employer's address.
|
| Employer's Address ZIP | Text |
Enter the ZIP code of the employer's address.
|
| Employer's Name | ||
| Employer's Name | Text |
Please enter the full legal name of your employer.
|
| Employment Status | ||
| Employed | Checkbox |
Check this box if you are currently employed.
|
| Not employed | Checkbox |
Check this box if you are currently not employed.
|
| Retired | Checkbox |
Check this box if you are retired.
|
| Occupation or Income Source | Text |
Please provide your current occupation or, if retired or not employed, indicate your source of income.
|
| Employed | Checkbox |
Check this box if you are currently employed.
|
| Not employed | Checkbox |
Check this box if you are currently not employed.
|
| Retired | Checkbox |
Check this box if you are retired.
|
| Employment Status Occupation | Text |
Enter your occupation or, if retired or not employed, indicate your source of income.
|
| Estimated Liquid Net Worth | ||
| Under $15,000 | Checkbox |
Check this box if your estimated liquid net worth is under $15,000.
|
| $15,000-$50,000 | Checkbox |
Check this box if your estimated liquid net worth is between $15,000 and $50,000.
|
| $50,001-$100,000 | Checkbox |
Check this box if your estimated liquid net worth is between $50,001 and $100,000.
|
| $100,001-$500,000 | Checkbox |
Check this box if your estimated liquid net worth is between $100,001 and $500,000.
|
| Over $500,000 | Checkbox |
Check this box if your estimated liquid net worth is over $500,000.
|
| Estimated Net Worth | ||
| Under $30,000 | Checkbox |
Check this box if your estimated net worth (excluding residence) is under $30,000.
|
| $30,000-$50,000 | Checkbox |
Check this box if your estimated net worth (excluding residence) is between $30,000 and $50,000.
|
| $50,001-$100,000 | Checkbox |
Check this box if your estimated net worth (excluding residence) is between $50,001 and $100,000.
|
| $100,001-$500,000 | Checkbox |
Check this box if your estimated net worth (excluding residence) is between $100,001 and $500,000.
|
| Over $500,000 | Checkbox |
Check this box if your estimated net worth (excluding residence) is over $500,000.
|
| Existing Account Confirmation | ||
| Existing Account Confirmation | Checkbox |
Check this box if you have an existing Non-Prototype Retirement Account with Fidelity and are adding a participant to your plan.
|
| Existing Fidelity Account Transfer | ||
| Transfer from Existing Fidelity Account | Checkbox |
Check this box if you are transferring all shares or positions from your Fidelity Mutual Fund Non-Prototype Retirement Account to your Fidelity Brokerage Non-Prototype Retirement Account.
|
| Existing Fidelity Account Transfer Account Number First Part | Text |
Enter the first segment of your existing Fidelity Non-Prototype Retirement Account number.
|
| Existing Fidelity Account Transfer Account Number Second Part | Text |
Enter the second segment of your existing Fidelity Non-Prototype Retirement Account number.
|
| Federal Tax Bracket | ||
| Federal Tax Bracket ≤15% | Checkbox |
Check this box if your federal tax bracket is less than or equal to 15%.
|
| Federal Tax Bracket 25% | Checkbox |
Check this box if your federal tax bracket is 25%.
|
| Federal Tax Bracket ≥28% | Checkbox |
Check this box if your federal tax bracket is greater than or equal to 28%.
|
| First Affiliate Information | ||
| First Affiliate Company Name | Text |
Enter the name of the first affiliated company.
|
| First Affiliate Trading Symbol or CUSIP | Text |
Enter the trading symbol or CUSIP for the first affiliated company.
|
| First Affiliate Company Name | Text |
Enter the name of the first affiliated company.
|
| First Affiliate Trading Symbol or CUSIP | Text |
Enter the trading symbol or CUSIP for the first affiliated company.
|
| First Purchase Fund | ||
| Fund Family 7 | Text | |
| Fund Name 7 | Text | |
| Fund Symbol 7 | Text | |
| Fund Amount 7 | Text | |
| Full Legal Name | ||
| Trustee 1 First Name | Text |
Enter the first name of Plan Trustee 1.
|
| Trustee 1 Middle Name | Text |
Enter the middle name of Plan Trustee 1.
|
| Trustee 1 Last Name | Text |
Enter the last name of Plan Trustee 1.
|
| Funding by Check | ||
| Funding by Check (I have enclosed a check) | Checkbox |
Check this box if you have enclosed a check made payable to Fidelity Investments to fund your account.
|
| Check Amount | Number |
Enter the dollar amount of the check enclosed for funding the account.
|
| Funding by Wire | ||
| I am wiring funds to Fidelity from my bank or brokerage firm | Checkbox |
Check this box if you are wiring funds to Fidelity from your bank or brokerage firm.
|
| General | ||
| Button | ||
| Reset | Button | |
| Save | Button | |
| Government ID Type | ||
| Passport Number | Checkbox |
Check this box if you are providing a Passport Number as your government identification.
|
| Permanent Resident Identifier | Checkbox |
Check this box if you are providing a Permanent Resident Identifier as your government identification.
|
| Other Government-Issued ID Number | Checkbox |
Check this box if you are providing an Other Government-Issued ID Number as your government identification.
|
| Passport Number | Checkbox |
Check this box if you are providing a Passport Number as your government identification.
|
| Permanent Resident Identifier | Checkbox |
Check this box if you are providing a Permanent Resident Identifier as your government identification.
|
| Other Government-Issued ID Number | Checkbox |
Check this box if you are providing an Other Government-Issued ID Number as your government identification.
|
| Government Identification | ||
| Government ID Number | Text |
Provide the government identification number.
|
| Country of Issuance | Text |
Enter the country that issued the government identification.
|
| ID Issuance Date | Date |
Enter the date the government identification was issued.
|
| ID Expiration Date | Date |
Enter the date the government identification will expire.
|
| Government Identification Details | ||
| Government ID Number | Text |
Enter your government identification number.
|
| Country of Issuance | Text |
Enter the country where the government identification was issued.
|
| ID Issuance Date | Date |
Enter the date when the government identification was issued.
|
| ID Expiration Date | Date |
Enter the date when the government identification expires.
|
| Interested Party for Duplicate Statements | ||
| Designate Interested Party for Duplicate Statements | Checkbox |
Check this box if you would like to name a participant or other party to receive duplicate statements and confirmations for this account.
|
| Interested Party Name | Text |
Enter the full name of the interested party who should receive duplicate statements and confirmations.
|
| Interested Party Street Address | Text |
Enter the street address for the interested party.
|
| Interested Party City | Text |
Enter the city for the interested party's address.
|
| Interested Party State | Text |
Enter the state for the interested party's address.
|
| Interested Party ZIP Code | Text |
Enter the ZIP code for the interested party's address.
|
| Investment Objective Profile | ||
| Investment Objective: Short-Term | Checkbox |
Check this box if your investment objective is short-term, focusing on capital preservation with the lowest returns for stability.
|
| Investment Objective: Conservative | Checkbox |
Check this box if your investment objective is conservative, indicating a lower risk tolerance than a balanced portfolio.
|
| Investment Objective: Balanced | Checkbox |
Check this box if your investment objective is balanced, aiming for a mix of growth and stability.
|
| Investment Objective: Growth | Checkbox |
Check this box if your investment objective is growth, indicating a higher risk tolerance for potentially greater returns.
|
| Investment Objective: Aggressive Growth | Checkbox |
Check this box if your investment objective is aggressive growth, indicating a high risk tolerance for significant returns.
|
| Investment Objective: Most Aggressive | Checkbox |
Check this box if your investment objective is most aggressive, seeking maximum growth while tolerating very wide fluctuations in performance.
|
| Mailing Address | ||
| Mailing Address Street | Text |
Enter the street name and number for the mailing address.
|
| Mailing Address City | Text |
Enter the city for the mailing address.
|
| Mailing Address State | Text |
Enter the state for the mailing address.
|
| Mailing Address ZIP | Text |
Enter the ZIP code for the mailing address.
|
| Mailing Street Address | Text |
Enter the street address for the mailing address.
|
| Mailing City | Text |
Enter the city for the mailing address.
|
| Mailing State | Text |
Enter the state for the mailing address.
|
| Mailing ZIP Code | Text |
Enter the ZIP code for the mailing address.
|
| Margin Credit Option | ||
| Margin Credit Option | Checkbox |
Check this box if your plan allows margin and you would like this account to be considered for this feature.
|
| Name of Participant | ||
| Participant First Name | Text |
Please provide the first name of the participant.
|
| Participant Middle Name | Text |
Please provide the middle name of the participant.
|
| Participant Last Name | Text |
Please provide the last name of the participant.
|
| Page 9 | ||
| Check Box 8c_Neither | CheckBox | |
| Permanent Address | ||
| Permanent Address Street | Text |
Provide the street name and building number for the permanent address.
|
| Permanent Address City | Text |
Enter the city for the permanent address.
|
| Permanent Address State | Text |
Specify the state for the permanent address.
|
| Permanent Address ZIP | Text |
Enter the ZIP code for the permanent address.
|
| Plan Name | ||
| Plan Name | Text |
Enter the name of the plan, for example, 'ABC Company 401(k) Plan'.
|
| Plan Structure | ||
| Plan Structure Option A | Checkbox |
Check this box if the plan is a trustee-directed pooled account where investments are owned at the plan level and choices are made by the trustee, and participants cannot effect transactions.
|
| Plan Structure Option B | Checkbox |
Check this box if the plan is an account for one participant (For the Benefit Of' [FBO] account) where assets are held in separate accounts for each participant.
|
| Plan Tax ID Number | ||
| Plan Tax ID Number | Text |
Enter the Plan Tax ID Number.
|
| SSN | Checkbox |
Check this box if the Plan Tax ID Number is a Social Security Number.
|
| EIN | Checkbox |
Check this box if the Plan Tax ID Number is an Employer Identification Number.
|
| ITIN | Checkbox |
Check this box if the Plan Tax ID Number is an Individual Taxpayer Identification Number.
|
| Plan's Permanent Address | ||
| Plan's Permanent Street Address | Text |
Enter the street address for the plan's permanent address. Do not use P.O. Boxes.
|
| Plan's Permanent City | Text |
Enter the city for the plan's permanent address.
|
| Plan's Permanent State | Text |
Enter the state for the plan's permanent address.
|
| Plan's Permanent ZIP Code | Text |
Enter the ZIP code for the plan's permanent address.
|
| Professional Association | ||
| Registered Investment Adviser | Checkbox |
Check this box if you are employed or associated with a Registered Investment Adviser.
|
| Broker-Dealer | Checkbox |
Check this box if you are employed or associated with a Broker-Dealer.
|
| Professional Associations | ||
| Employed/Associated with Registered Investment Adviser | Checkbox |
Check this box if you are employed by or associated with a Registered Investment Adviser.
|
| Employed/Associated with Broker-Dealer | Checkbox |
Check this box if you are employed by or associated with a Broker-Dealer.
|
| Residency Status | ||
| Permanent U.S. resident | Checkbox |
Check this box if the individual is a permanent resident of the United States.
|
| Nonpermanent U.S. resident | Checkbox |
Check this box if the individual is a nonpermanent resident of the United States.
|
| Nonresident of U.S. | Checkbox |
Check this box if the individual is not a resident of the United States.
|
| Permanent U.S. resident | Checkbox |
Check this box if you are a permanent resident of the United States.
|
| Nonpermanent U.S. resident | Checkbox |
Check this box if you are a nonpermanent resident of the United States.
|
| Nonresident of U.S. | Checkbox |
Check this box if you are not a resident of the United States.
|
| Second Affiliate Information | ||
| T2 Control Company Name 4c2 | Text | |
| T2 Trading Symbol 4c2 | Text | |
| Second Affiliate's Company Name | Text |
Enter the name of the second affiliate's company.
|
| Second Affiliate's Trading Symbol or CUSIP | Text |
Enter the trading symbol or CUSIP for the second affiliate's company.
|
| Second Purchase Fund | ||
| Second Purchase Fund Family | Text |
Enter the family name of the second fund you wish to purchase.
|
| Second Purchase Fund Name | Text |
Enter the full name of the second fund you wish to purchase.
|
| Second Purchase Fund Symbol | Text |
Enter the stock ticker symbol for the second fund you wish to purchase.
|
| Second Purchase Amount | Number |
Enter the monetary amount you wish to invest in the second fund.
|
| Sponsoring Company Name | ||
| Sponsoring Company Name | Text |
Enter the full legal name of the sponsoring company.
|
| State/Country of Organization | ||
| State/Country of Organization | Text |
Provide the state or country where the organization is located.
|
| Taxpayer ID Number | ||
| Participant Taxpayer ID Number | Text |
Please enter the participant's Taxpayer ID Number.
|
| SSN | Checkbox |
Check this box if the Taxpayer ID Number provided is a Social Security Number.
|
| EIN | Checkbox |
Check this box if the Taxpayer ID Number provided is an Employer Identification Number.
|
| ITIN | Checkbox |
Check this box if the Taxpayer ID Number provided is an Individual Taxpayer Identification Number.
|
| Taxpayer ID Number | Text |
Enter the Taxpayer Identification Number for Plan Trustee 1.
|
| SSN | Checkbox |
Check this box if the Taxpayer ID Number for Plan Trustee 1 is a Social Security Number.
|
| EIN | Checkbox |
Check this box if the Taxpayer ID Number for Plan Trustee 1 is an Employer Identification Number.
|
| ITIN | Checkbox |
Check this box if the Taxpayer ID Number for Plan Trustee 1 is an Individual Taxpayer Identification Number.
|
| Transfer from Other Firm | ||
| Transfer from Other Firm | Checkbox |
Check this box if you are transferring money or securities from another financial institution and have included a completed Transfer of Assets form.
|
| Trustee 2 Contact Information | ||
| Trustee 2 Mailing Address Street | Text |
Provide the street portion of Trustee 2's mailing address.
|
| Trustee 2 Mailing Address State | Text |
Provide the state for Trustee 2's mailing address.
|
| Trustee 2 Mobile Phone Number | Text |
Provide Trustee 2's mobile phone number.
|
| Trustee 2 Date of Birth | ||
| Trustee 2 Date of Birth | Date |
Enter the date of birth for Trustee 2.
|
| Trustee 2 Full Legal Name | ||
| Trustee 2 First Name | Text |
Enter the first name of Trustee 2.
|
| Trustee 2 Middle Name | Text |
Enter the middle name of Trustee 2.
|
| Trustee 2 Last Name | Text |
Enter the last name of Trustee 2.
|
| Trustee 2 Mailing Address | ||
| Trustee 2 Mailing Address Street | Text |
Enter the street address for Trustee 2's mailing address.
|
| Trustee 2 Mailing Address City | Text |
Enter the city for Trustee 2's mailing address.
|
| Trustee 2 Mailing Address State | Text |
Enter the state for Trustee 2's mailing address.
|
| Trustee 2 Mailing Address ZIP Code | Text |
Enter the ZIP code for Trustee 2's mailing address.
|
| Trustee 2 Permanent Address | ||
| Trustee 2 Permanent Address Street | Text |
Enter the street name and number for Trustee 2's permanent residence.
|
| Trustee 2 Permanent Address City | Text |
Enter the city for Trustee 2's permanent residence.
|
| Trustee 2 Permanent Address State | Text |
Enter the state for Trustee 2's permanent residence.
|
| Trustee 2 Permanent Address ZIP | Text |
Enter the ZIP code for Trustee 2's permanent residence.
|
| Trustee 2 Taxpayer ID Number | ||
| Trustee 2 Taxpayer ID Number | Text |
Enter the Taxpayer Identification Number for Trustee 2.
|
| Trustee 2 SSN | Checkbox |
Check this box if the Taxpayer ID Number for Trustee 2 is a Social Security Number (SSN).
|
| Trustee 2 EIN | Checkbox |
Check this box if the Taxpayer ID Number for Trustee 2 is an Employer Identification Number (EIN).
|
| Trustee 2 ITIN | Checkbox |
Check this box if the Taxpayer ID Number for Trustee 2 is an Individual Taxpayer Identification Number (ITIN).
|
| Type of Plan | ||
| 401(k) | Checkbox |
Check this box if your company's retirement plan is a 401(k) plan.
|
| Profit Sharing | Checkbox |
Check this box if your company's retirement plan is a Profit Sharing plan.
|
| Money Purchase | Checkbox |
Check this box if your company's retirement plan is a Money Purchase plan.
|
| Defined Benefit/Pension Plan | Checkbox |
Check this box if your company's retirement plan is a Defined Benefit or Pension Plan.
|
| Other Qualified Plan | Checkbox |
Check this box if your company's retirement plan is an Other Qualified Plan.
|
| Other Qualified Plan Type | Text |
Provide the specific type of the other qualified plan.
|