Fidelity Investments® Beneficiary Distribution Form Completed Form Examples and Samples
Find clear, filled-out examples and samples of the Fidelity Investments® Beneficiary Distribution Form. Our detailed guides show you how to correctly complete the form for inherited IRAs, 401(k)s, and other accounts, helping you navigate the process of claiming assets.
Fidelity Investments® Beneficiary Distribution Form Example – Inherited IRA Rollover
How this form was filled:
This example shows a non-spouse beneficiary (a daughter) completing the Fidelity Beneficiary Distribution Form to claim assets from her deceased father's Traditional IRA. She has elected to directly roll over the entire balance into a new Inherited IRA, a common strategy to maintain tax-deferred growth.
Information used to fill out the document:
- Decedent's Name: Johnathan P. Smith
- Decedent's Social Security Number: 111-00-2222
- Decedent's Date of Death: November 15, 2025
- Fidelity Account Number (Decedent): Z12-345678
- Beneficiary's Name: Emily R. Smith
- Beneficiary's Relationship: Daughter
- Beneficiary's Social Security Number: 999-88-7777
- Beneficiary's Date of Birth: June 10, 1990
- Beneficiary's Mailing Address: 456 Oak Avenue, Anytown, ST 12345
- Beneficiary's Phone Number: 555-123-4567
- Distribution Option Selected: Section 3A: Move assets to a new Fidelity Inherited IRA
- Distribution Amount: Full Account Balance
- Signature: Emily R. Smith
- Date of Signature: January 22, 2026
What this filled form sample shows:
- Clearly completed information for both the decedent and the beneficiary.
- Correct selection of the Inherited IRA rollover option to preserve tax-deferred status.
- Indicates that a certified copy of the death certificate is required to be attached.
- The form is properly signed and dated by the beneficiary making the claim.
Form specifications and details:
| Form Name: | Fidelity Investments® Beneficiary Distribution Form |
| Use Case: | Non-spouse beneficiary claiming a Traditional IRA. |
| Distribution Method: | Direct Rollover to an Inherited IRA. |
| Account Type: | Retirement (Traditional IRA) |
Created: February 25, 2026 05:38 PM
