Fidelity Stock Plan Services (SPS) Transfer Request Form Instructions
This form contains 43 fields organized into 13 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Cash Asset Transfer Method | ||
| Check to Address of Contra Broker | Checkbox |
Check this box if cash assets are to be transferred via a check sent to the address of a contra broker.
|
| Wire Transfer | Checkbox |
Check this box if cash assets are to be transferred via wire and you will attach specific instructions.
|
| Contra Broker Information | ||
| Receiving Contra Broker Name | Text |
Please enter the name of the receiving contra broker.
|
| Contra Broker DTC Number | Text |
Please provide the DTC number of the contra broker.
|
| Contra Broker Account Number | Text |
Please enter the account number at the contra broker.
|
| Contra Broker Account Registration | Text |
Please provide the registration details of the account at the contra broker.
|
| Contra Broker Account SSN or TIN | Text |
Please enter the Social Security Number (SSN) or Tax Identification Number (TIN) of the account at the contra broker.
|
| Contra Broker Address | Text |
Please provide the full address of the contra broker.
|
| Customer Information | ||
| Name of Owner | Text | |
| SS Number | Text | |
| Fidelity Acct number | Text | |
| Co-owner | Text | |
| SS number or TIN | Text | |
| AO Phone number | Text | |
| First Specific Share | ||
| First Specific Share Security or Fund Name | Text |
Enter the name of the security or fund for the first specific share.
|
| First Specific Share Symbol | Text |
Enter the ticker symbol for the first specific share.
|
| First Specific Share Number of Shares | Number |
Enter the number of shares from the tax lot for the first specific share.
|
| First Specific Share Date Acquired | Date |
Enter the date the first specific share was acquired.
|
| First Specific Share Total Cost Basis per Share | Number |
Enter the total cost basis per share for the first specific share.
|
| General | ||
| Button | ||
| Reset | Button | |
| Save | Button | |
| Gift Recipient Information | ||
| Gift Recipient Name/Registration | Text |
Please enter the name or registration details for the gift recipient.
|
| Gift Recipient SSN or TIN | Text |
Please provide the Social Security Number (SSN) or Tax Identification Number (TIN) for the gift recipient.
|
| Page 2 | ||
| Account Owner Print Name | Text |
Enter the printed full name of the account owner.
|
| Co-owner Print Name | Text |
Enter the printed full name of the co-owner.
|
| Quantity | ||
| Quantity | Checkbox |
Check this box if you need to specify a particular quantity for the transfer.
|
| Quantity | Number |
Please enter the quantity for the request.
|
| Request Type | ||
| Gift | Checkbox |
Check this box if your request is to transfer assets as a gift.
|
| Full Transfer | Checkbox |
Check this box if your request is for a full transfer of assets.
|
| Partial Transfer | Checkbox |
Check this box if your request is for a partial transfer of assets; please review the attachment to ensure your request can be processed as a transfer.
|
| Second Specific Share | ||
| Second Specific Share: Security or Fund Name | Text |
Enter the name of the security or fund for the second specific share.
|
| Second Specific Share: Symbol | Text |
Enter the symbol for the second specific share.
|
| Second Specific Share: Number of Shares from Tax Lot | Number |
Enter the number of shares from the tax lot for the second specific share.
|
| Second Specific Share: Date Acquired | Date |
Enter the date the second specific share was acquired.
|
| Second Specific Share: Total Cost Basis per Share | Number |
Enter the total cost basis per share for the second specific share.
|
| Specific Shares Option | ||
| Specific Shares | Checkbox |
Check this box if you wish to specify particular shares for the transfer.
|
| Stock Information | ||
| Stock Name, Symbol, and CUSIP Number | Text |
Enter the stock name, symbol, and CUSIP number for the shares.
|
| Third Specific Share | ||
| Third Specific Share Security or Fund Name | Text |
Enter the security or fund name for the third specific share.
|
| Third Specific Share Symbol | Text |
Enter the ticker symbol for the third specific share.
|
| Third Specific Share Number of Shares from Tax Lot | Number |
Enter the number of shares from the tax lot for the third specific share.
|
| Third Specific Share Date Acquired | Date |
Enter the date the third specific share was acquired.
|
| Third Specific Share Total Cost Basis per Share | Number |
Enter the total cost basis per share for the third specific share.
|