Fidelity Stock Plan Services (SPS) Transfer Request Form Completed Form Examples and Samples
Browse real-world examples and samples of completed Fidelity Stock Plan Services (SPS) Transfer Request Forms. Each example includes step-by-step field explanations, sample data, and tips for correctly transferring vested shares, RSUs, stock options, and other equity awards from your Fidelity SPS account.
Fidelity SPS Transfer Request Form Example – Employee Stock Option Transfer to Individual Brokerage Account
How this form was filled:
This example shows a fully completed Fidelity Stock Plan Services (SPS) Transfer Request Form for an employee transferring vested company stock shares from their SPS account to an individual Fidelity brokerage account. The participant's personal information, employer/plan details, receiving account number, and transfer instructions are all properly filled out, including share quantity, stock symbol, and authorization signature.
Information used to fill out the document:
- Participant First Name: Michael
- Participant Middle Initial: R
- Participant Last Name: Thompson
- Social Security Number (SSN): XXX-XX-4782
- Date of Birth: 03/14/1985
- Daytime Phone Number: (614) 555-0193
- Email Address: [email protected]
- Street Address: 4821 Elmwood Drive
- City: Columbus
- State: OH
- ZIP Code: 43215
- Employer / Company Name: Nexagen Technologies Inc.
- Stock Plan Name: Nexagen Technologies 2019 Equity Incentive Plan
- Stock Ticker Symbol: NXGT
- Type of Award: Restricted Stock Units (RSUs)
- Number of Shares to Transfer: 350
- Transfer Type: In-Kind Transfer (shares transferred as-is, no liquidation)
- Reason for Transfer: Transfer to Personal Brokerage Account
- Receiving Account Type: Individual Taxable Brokerage Account
- Receiving Fidelity Account Number: Z48-391025
- Receiving Account Owner Name: Michael R. Thompson
- Medallion Signature Guarantee Required: No
- Participant Signature: Michael R. Thompson
- Date Signed: 02/11/2026
What this filled form sample shows:
- Correctly completed participant personal information section including full legal name, SSN (partially masked), date of birth, and contact details
- Properly identified employer and stock plan details, including the company name, equity plan name, and stock ticker symbol
- Clear specification of award type (RSUs) and the exact number of shares (350) requested for transfer
- Accurate selection of in-kind transfer as the transfer type, preserving shares without triggering a sale
- Correctly entered receiving Fidelity brokerage account number and account owner name for seamless routing
- Properly completed authorization signature and date confirming participant consent for the transfer
- Appropriate notation that Medallion Signature Guarantee is not required for this transfer type
Form specifications and details:
| Use Case: | Employee transferring vested RSU shares from an employer-sponsored Fidelity SPS account to a personal Fidelity individual brokerage account |
| Transfer Method: | In-Kind (shares transferred without liquidation) |
| Award Type: | Restricted Stock Units (RSUs) |
| Shares Transferred: | 350 shares of NXGT |
| Receiving Account Type: | Individual Taxable Brokerage Account |
| Medallion Signature Guarantee: | Not required |
| Form Purpose: | Authorize the movement of vested equity compensation shares between Fidelity-held accounts |
| Applicable Participant: | Active employee with fully vested RSUs seeking to consolidate holdings into a personal brokerage account |
| Tax Consideration: | In-kind transfer does not trigger a taxable event at time of transfer; taxes apply upon original vesting |
Created: February 24, 2026 03:53 AM
