Fidelity Investments Transfer/Rollover/Exchange Form Completed Form Examples and Samples
Explore real-world filled examples of the Fidelity Investments Transfer/Rollover/Exchange Form, including 401(k) rollovers to Traditional IRAs, Roth conversions, and direct transfers. Each sample walks you through every field with realistic data to help you complete your own form accurately and avoid common mistakes.
Fidelity Investments Transfer/Rollover/Exchange Form Example – 401(k) Rollover to Traditional IRA
How this form was filled:
This example shows how a participant rolls over a former employer's 401(k) balance directly into a Fidelity Traditional IRA. The form captures the account owner's personal details, the delivering institution's information, the receiving Fidelity IRA account number, the transfer type (direct rollover), and the liquidation instructions. The form is signed and dated in early 2026.
Information used to fill out the document:
- Account Owner Full Name: Michael R. Thompson
- Social Security Number: XXX-XX-4321
- Date of Birth: March 14, 1978
- Phone Number: (614) 555-0192
- Mailing Address: 4802 Elmwood Drive, Columbus, OH 43215
- Receiving Fidelity Account Type: Traditional IRA
- Receiving Fidelity Account Number: 123-456789
- Delivering Institution Name: Vanguard Institutional
- Delivering Institution Phone: (800) 555-0374
- Delivering Institution Address: 100 Vanguard Blvd, Malvern, PA 19355
- Delivering Account Number: 98765-4321
- Delivering Account Type: 401(k) – Former Employer Plan
- Former Employer Name: Hartwell Manufacturing Group
- Transfer Type: Direct Rollover (Trustee-to-Trustee)
- Liquidation Amount: Full Account Balance
- Estimated Account Value: $87,500.00
- Investment Instructions: Fidelity Freedom® 2040 Fund (FFFFX)
- Special Instructions: Please liquidate all holdings and transfer cash proceeds
- Signature: Michael R. Thompson
- Date Signed: January 22, 2026
What this filled form sample shows:
- Correctly completed account owner personal information including SSN, date of birth, and mailing address
- Accurate delivering institution details with Vanguard Institutional account number and contact information
- Proper selection of Direct Rollover (Trustee-to-Trustee) transfer type to avoid mandatory 20% withholding
- Full account balance liquidation instruction covering the entire $87,500 401(k) balance
- Designated receiving Fidelity Traditional IRA account number to ensure funds land in the correct account
- Target-date fund investment election using Fidelity Freedom® 2040 Fund aligned with the owner's expected retirement year
- Properly signed and dated authorization section with a January 2026 date
- Inclusion of former employer plan name (Hartwell Manufacturing Group) required for employer plan rollovers
Form specifications and details:
| Use Case: | Direct 401(k) rollover to Fidelity Traditional IRA after leaving an employer |
| Form Name: | Fidelity Investments Transfer/Rollover/Exchange Form |
| Transfer Direction: | Outbound from Vanguard 401(k) → Inbound to Fidelity Traditional IRA |
| Transfer Type: | Direct Rollover (Trustee-to-Trustee) |
| Tax Implications: | No immediate tax liability; funds transferred directly between custodians |
| Withholding: | Not applicable for direct rollover |
| Eligible Account Types: | 401(k), 403(b), Traditional IRA, Roth IRA, SIMPLE IRA, SEP-IRA |
| Receiving Account Type: | Traditional IRA |
| Liquidation Preference: | Full Account Balance |
| Estimated Transfer Value: | $87,500.00 |
| Processing Time: | Typically 3–5 business days after delivering institution approval |
| Signature Requirement: | Account owner signature and date required |
| Medallion Signature Guarantee: | Not required for standard IRA rollovers |
| Form Purpose: | Initiate transfer, rollover, or exchange of retirement assets to a Fidelity account |
Created: February 24, 2026 03:58 AM
