Yes! You can use AI to fill out Fidelity NetBenefits Distribution—Rollover Form
The Fidelity NetBenefits Distribution—Rollover form is an official Fidelity Investments document that allows workplace retirement plan participants to request a rollover of their plan assets—including pre-tax, after-tax, and Roth funds—into an IRA or another employer-sponsored plan. It is a critical form for individuals changing jobs, retiring, or otherwise separating from service who wish to preserve the tax-advantaged status of their retirement savings. The form requires information about the account owner, employer plan details, distribution reason, destination accounts, tax withholding preferences, and in some cases, spousal consent and plan sponsor approval. 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.
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Form specifications
| Form name: | Fidelity NetBenefits Distribution—Rollover Form |
| Number of pages: | 1 |
| Filled form examples: | Form Fidelity Distribution—Rollover Examples |
| Language: | English |
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How to Fill Out Fidelity Distribution—Rollover Online for Free in 2026
Are you looking to fill out a FIDELITY DISTRIBUTION—ROLLOVER form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your FIDELITY DISTRIBUTION—ROLLOVER form in just 37 seconds or less.
Follow these steps to fill out your FIDELITY DISTRIBUTION—ROLLOVER form online using Instafill.ai:
- 1 Navigate to Instafill.ai and upload the Fidelity Distribution—Rollover PDF form or select it from the available form library to begin filling it out online.
- 2 Complete Section 1 by entering your personal information, including your full name, Social Security or Taxpayer ID number, date of birth, phone numbers, email address, marital status, and current mailing address.
- 3 Fill in Section 2 with your employer's name and the plan number(s) from which you are requesting the rollover distribution, then select your reason for distribution in Section 3 (e.g., separation from service, age qualification, or disability).
- 4 Complete Section 4 by specifying whether you want to roll over all or some plan assets, selecting the destination account type (Rollover IRA, Roth IRA, or employer-sponsored plan), and providing the investment provider name and account number for each asset type.
- 5 Indicate your tax withholding preferences in Section 5, including federal and state withholding rates or amounts, and select your preferred delivery method for any checks in Section 6.
- 6 If required by your plan, have your spouse complete and sign Section 7 (Spouse's Consent) with notarization or a plan representative witness, and obtain plan sponsor approval in Section 9 if your plan requires it.
- 7 Review all entered information for accuracy, sign and date Section 8 as the account owner/participant, obtain a signature guarantee if required, and submit the completed form to Fidelity via the NetBenefits Mobile App, regular mail, or overnight mail.
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Frequently Asked Questions About Form Fidelity Distribution—Rollover
This form is used to request a rollover distribution from your 401(a), 401(k), 403(b), or 457(b) governmental employer plan. It allows you to move your retirement savings to another qualified account such as a Rollover IRA, Roth IRA, or another employer-sponsored plan.
You can use this form if you meet one of the eligibility criteria listed in Section 3, such as being a current employee who is qualified by age (at least 59½, or 70½ for 457(b) plans), having a disability, or being a former employee who has separated from service. Beneficiaries and qualified alternate payees should call Fidelity directly instead of using this form.
You will need your full name, Social Security or Taxpayer ID number, date of birth, phone numbers, email address, mailing address, and your employer's plan sponsor name and plan number(s). You can find your plan number(s) by logging into NetBenefits at www.NetBenefits.com and selecting 'Summary' under Quick Links.
Yes, but the destination account depends on the asset type. Pre-tax (non-Roth) and after-tax (non-Roth) assets can be rolled into a Rollover IRA, Roth IRA, or employer-sponsored plan, while Roth assets can only go into a Roth IRA or an employer-sponsored plan that accepts Roth assets. Note that rolling non-Roth assets into a Roth IRA is considered a conversion and may result in tax liability.
If you are married, your spouse may need to sign Section 7 depending on your plan's requirements. The spouse's signature must be either notarized or witnessed by a plan representative — a signature guarantee is not sufficient. The consent expires if the distribution is not processed within 180 days of the spouse's signature.
It depends on your specific plan. You should check with your plan sponsor or Fidelity to determine if plan sponsor approval is required — this may apply even if you no longer work for the sponsor. If your plan requires it and there is no plan sponsor signature in Section 9, your request will be denied.
For U.S. persons, a minimum federal mandatory withholding rate of 20% applies to taxable benefits not rolled over. For non-resident aliens, the minimum rate is 30% unless a tax treaty rate applies. If you are under age 59½, an additional 10% early distribution tax penalty may also apply.
For rollovers to non-Fidelity plans or accounts, you will receive a check payable to the destination firm. You can choose to have the check sent to your mailing address (allow 7 business days) or via UPS delivery for a $25 fee (allow 2 business days). Note that check delivery is not available for PO Box or foreign addresses.
A signature guarantee is required if your distribution is more than $100,000 and it is not going to a Fidelity account, and your plan does not require a plan sponsor signature. You can obtain a Medallion signature guarantee from most banks, credit unions, or financial institutions — note that a notary seal is NOT the same as a signature guarantee.
You can submit the completed form digitally using the NetBenefits Mobile App (tap Actions > Send a Document), by regular mail to Fidelity Investments, PO Box 770002, Cincinnati, OH 45277-0090, or by overnight mail to 100 Crosby Parkway, KC1E, Covington, KY 41015. Make sure all required signatures are included before submitting.
Yes, AI-powered services like Instafill.ai can help you accurately auto-fill the form fields, saving you time and reducing errors. Simply upload the form to Instafill.ai, and the tool will guide you through completing all required sections efficiently.
To fill out this form online, visit Instafill.ai and upload the Distribution—Rollover PDF. The AI will help you complete all fields — including personal information, plan details, rollover destination, and tax withholding preferences — and you can then download, sign, and submit the completed form to Fidelity.
If your PDF is a flat, non-fillable version, Instafill.ai can convert it into an interactive fillable form so you can complete it digitally. This eliminates the need to print and fill it out by hand, making the process faster and more convenient.
You must submit a separate Distribution—Rollover form for each employer. Section 2 only allows you to list plans sponsored by a single employer, so if you have retirement accounts with different employers, each requires its own form submission.
Yes, non-resident aliens must provide IRS Form W-8BEN and a U.S. taxpayer ID number to claim any applicable tax treaty benefits. Without a valid W-8BEN on file with Fidelity, the minimum federal mandatory withholding rate of 30% will apply to your distribution.
Compliance Fidelity Distribution—Rollover
Validation Checks by Instafill.ai
1
Social Security or Taxpayer ID Number Format Validation
Validates that the Social Security Number (SSN) or Taxpayer ID Number (TIN) is entered in the correct 9-digit format (XXX-XX-XXXX for SSN or XX-XXXXXXX for EIN). This field is required for identity verification and IRS tax reporting purposes. If the format is invalid or the field is left blank, the distribution request cannot be processed and may be rejected by Fidelity.
2
Date of Birth Format and Age Eligibility Check
Validates that the Date of Birth is entered in the correct MM DD YYYY format and that the date is a valid calendar date (e.g., no month 13 or day 32). Additionally, cross-references the date of birth against the selected Reason for Distribution to confirm age eligibility — for example, if 'Qualified by age' is selected, the participant must be at least 59½ (or 70½ for 457(b) plans). If the participant does not meet the age requirement for the selected reason, the form should flag an eligibility conflict.
3
Required Reason for Distribution Selection
Validates that exactly one reason for distribution is selected in Section 3, and that the selection is appropriate for the participant's employment status (current vs. former employee). The form explicitly states that only one reason may be checked, and federal tax law requires a valid reason for any distribution. If no reason is selected or multiple reasons are checked, the request will be invalid and must be returned for correction.
4
Rollover Destination and Asset Type Compatibility Check
Validates that the selected rollover destination account type is compatible with the asset type being rolled over, per IRS rules. Specifically, Roth assets cannot be rolled into a Rollover IRA, and rolling non-Roth assets into a Roth IRA constitutes a taxable conversion. If an incompatible destination is selected for a given asset type, the form should flag the mismatch to prevent an invalid or unintended taxable transaction.
5
Plan Number Format and Completeness Validation
Validates that at least one Plan Number is provided in Section 2 and that all entered plan numbers conform to the expected numeric format used by Fidelity. Plan numbers are required to identify which specific retirement accounts are subject to the distribution request. If no plan number is provided or the format is incorrect, Fidelity cannot process the distribution against the correct account.
6
Rollover Percentage Field Range Validation
Validates that any percentage entered for a partial rollover (e.g., 'Rollover a percentage of pre-tax assets') is a numeric value between 1 and 100, and that it does not exceed 100% when combined with other distribution elections. Entering a percentage outside this range or a non-numeric value would result in an ambiguous or mathematically impossible distribution instruction. The form should reject any percentage entry that is zero, negative, or greater than 100.
7
Participant Signature and Date Completeness Check
Validates that the participant has both signed and dated Section 8, and that the date is in the correct MM DD YYYY format and is not a future date. The participant's signature is mandatory to authorize Fidelity to act on the distribution instructions and to certify the accuracy of all information provided. A missing signature or date will result in automatic rejection of the form.
8
Spouse Consent Section Completeness When Married
Validates that if the participant has indicated they are married in Section 1 and the plan requires spousal consent, Section 7 is fully completed including the spouse's printed name, signature, and date. The spouse's signature must be either notarized or witnessed by a plan representative, and the consent is only valid for 180 days from the date signed. If the spouse's consent section is incomplete when required, the distribution request must be denied per plan rules.
9
Notary Commission Expiration Date Validation
Validates that the notary's commission expiration date provided in Section 7 is a valid date in MM DD YYYY format and that the commission has not already expired as of the date the form is signed. A notarization performed by a notary with an expired commission is legally invalid and would render the spousal consent unenforceable. If the commission expiration date is missing or has passed, the notarization must be flagged as potentially invalid.
10
State Tax Withholding Dollar Amount Minimum for Applicable States
Validates that residents of NY, NM, NJ, ND, PA, and RI who elect state tax withholding have entered a dollar amount of at least $10, as required by the form instructions. Entering an amount below $10 or leaving the field blank when withholding is desired will result in no state taxes being withheld, which could lead to unexpected tax liability for the participant. The validation should also confirm the entered value is numeric and properly formatted as a dollar amount.
11
Signature Guarantee Requirement Check for Large Non-Fidelity Distributions
Validates that a Medallion signature guarantee is provided in Section 8 when the distribution amount exceeds $100,000 and the destination is not a Fidelity account, and when no plan sponsor signature is present in Section 9. The Medallion signature guarantee must be from an eligible institution and must guarantee at least the amount of the distribution. If this requirement is not met, the form should flag that the distribution cannot be processed without the appropriate guarantee.
12
Plan Sponsor Approval Section Completeness When Required
Validates that Section 9 is fully completed — including the Plan Representative's printed name, signature, date, and participant's date of hire — when the plan requires sponsor approval of rollover requests. The form explicitly warns that if plan sponsor approval is required and Section 9 is unsigned, the request will be denied. The hire date and separation date (if applicable) must also be in valid MM DD YYYY format, and the separation date must not precede the hire date.
13
Investment Provider Name Required When Non-Fidelity Destination Selected
Validates that the 'Investment Provider or Employer-Sponsored Plan Name' field is populated whenever the participant selects a non-Fidelity rollover destination (i.e., a Rollover IRA, Roth IRA, or employer-sponsored plan not held at Fidelity). Without the receiving institution's name, Fidelity cannot make the rollover check payable to the correct firm. If this field is blank while a non-Fidelity destination is indicated, the form should be flagged as incomplete.
14
Daytime Phone Number Format Validation
Validates that the Daytime Phone number is entered in a standard 10-digit U.S. format (e.g., XXX-XXX-XXXX) and contains only numeric characters. A valid phone number is necessary for Fidelity to contact the participant if there are questions or issues with the distribution request. If the phone number is missing, contains letters, or has fewer than 10 digits, the form should flag it as an invalid entry.
15
Address Completeness and Delivery Method Compatibility Check
Validates that if a new address is provided in Section 1, all required address fields (Address, City, State/Province, Zip/Postal Code, Country) are fully completed. Additionally, validates that if the UPS delivery option is selected in Section 6, the address on file is not a PO Box or a foreign address, as the form explicitly states this delivery method is unavailable for those address types. An incomplete address or an incompatible address-delivery method combination should be flagged to prevent processing delays or failed delivery.
16
Separation Date Logical Consistency with Employment Status
Validates that if 'Separation from service' is selected as the reason for distribution in Section 3, a valid Separation Date is provided in Section 9 and that the date is not in the future. Conversely, if a current employee reason (e.g., 'Qualified by age' or 'Disability') is selected, a separation date should not be present, as this would indicate a logical inconsistency in the participant's employment status. Mismatches between the stated reason for distribution and the separation date could indicate an eligibility error that must be resolved before processing.
Common Mistakes in Completing Fidelity Distribution—Rollover
People often transpose digits or enter an ITIN when an SSN is expected (or vice versa), especially when filling out the form quickly. An incorrect SSN can cause Fidelity to be unable to locate the account, resulting in the request being rejected or significantly delayed. Always double-check the number against your Social Security card or a prior tax document before submitting. AI-powered form filling tools like Instafill.ai can help by auto-populating and validating your SSN format to reduce transcription errors.
Many participants check a distribution reason without first confirming with their plan sponsor that their plan accepts that specific reason and that they personally qualify. For example, checking 'Qualified by age' without meeting the plan's minimum age requirement (59½ for most plans, 70½ for 457(b)) will result in the request being denied. The form explicitly warns that only one reason may be checked and that eligibility varies by plan. Always contact your plan sponsor before completing Section 3 to confirm which reasons are accepted and whether you qualify.
A very common and costly mistake is attempting to roll Roth assets into a traditional Rollover IRA, which is not permitted under IRS rules. The form clearly states that Roth assets can only be rolled into a Roth IRA or an employer-sponsored plan that accepts Roth assets, but participants often overlook this distinction. This error can result in the rollover being rejected or causing unintended tax consequences. Carefully review the asset type table in Section 4 and ensure the destination account type matches the asset type being rolled over.
Many participants submit the form without a plan sponsor signature in Section 9, not realizing their specific plan requires it. The form explicitly states that if plan sponsor approval is required and Section 9 is unsigned, the request will be denied outright. This mistake causes significant delays as the form must be resubmitted from scratch. Before filling out the form, contact your plan sponsor or Fidelity to determine whether plan sponsor approval is required for your rollover request.
Participants frequently leave the plan number fields blank or enter an incorrect number because they are unsure where to find this information. An incorrect plan number can cause the distribution to be applied to the wrong plan or rejected entirely. The form directs participants to log into NetBenefits.com under Quick Links > Summary to retrieve their plan number(s). Note that only plans sponsored by the same employer should be listed on a single form; distributions from different employers require separate forms.
Many participants are surprised to learn that a mandatory 20% federal withholding applies to taxable amounts not rolled over, and they either fail to account for this or incorrectly try to opt out of it. Attempting to indicate a rate below the federal minimum will result in Fidelity automatically applying the minimum rate by law. Additionally, participants under age 59½ may face an additional 10% early distribution penalty. Review Section 5 carefully and consult a tax professional to understand the full tax impact before requesting a distribution.
Married participants frequently skip Section 7 or complete it improperly, not realizing their plan may require spousal consent for a rollover distribution. A common error is obtaining a signature guarantee instead of a notarization or plan representative witness signature — the form explicitly states that a signature guarantee is NOT a notary seal. If spousal consent is required and Section 7 is incomplete or improperly witnessed, the entire request will be denied. Check with your plan sponsor whether spousal consent is required and ensure the signature is properly notarized or witnessed by a plan representative.
When participants update their mailing address directly on the form in Section 1, they often do not realize this can delay the delivery of their check unless a signature guarantee is also provided in Section 9. Fidelity flags address changes as a security measure, and without the guarantee, processing may be held up. To avoid delays, update your address in advance through netbenefits.com/profile or by calling your plan sponsor before submitting the distribution form. AI-powered tools like Instafill.ai can flag this requirement automatically when a new address is detected.
Participants often leave the Investment Provider or Employer-Sponsored Plan Name and Fidelity Account Number fields incomplete or enter incorrect account numbers for the destination IRA or plan. For non-Fidelity rollovers, a check will be made payable to the receiving firm, and incorrect information can result in the check being undeliverable or rejected by the receiving institution. For Fidelity IRAs, an incorrect account number can cause funds to be deposited into the wrong account. Always verify the exact account number and institution name with the receiving firm before completing Section 4.
Participants frequently complete both the 'Move ALL Plan Assets' and 'Move SOME Plan Assets' sections simultaneously, or they select 'Move SOME' but fail to specify a dollar amount or percentage, leaving the source field blank. This creates conflicting instructions that Fidelity cannot process, resulting in the request being returned or denied. The form instructs participants to choose only one source option under 'Move SOME Plan Assets.' Read Section 4 carefully, decide in advance exactly how much you want to roll over, and complete only the relevant subsection.
Dates on this form must be entered in MM DD YYYY format across multiple sections, including Date of Birth, Spouse's Consent date, Participant Signature date, Date of Hire, and Separation Date. Participants commonly enter dates in the wrong format (e.g., MM/DD/YY or YYYY-MM-DD), leave date fields blank, or enter an incorrect date of birth that doesn't match Fidelity's records. Incorrect dates can cause identity verification failures or eligibility issues. Double-check all date fields before submitting, and use tools like Instafill.ai to automatically format dates correctly.
For distributions over $100,000 that are not going to a Fidelity account, a Medallion signature guarantee is required if the plan sponsor has not signed Section 9. Many participants either skip this requirement entirely or confuse a notary seal with a Medallion signature guarantee — the form explicitly states these are not the same thing. Submitting without the proper guarantee will result in the request being rejected. Obtain a Medallion signature guarantee from a bank, credit union, or other qualified financial institution, and ensure it covers at least the full amount of your distribution.
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