Fidelity Transfer of Assets Form (TOA) - Your Veolia Benefits Instructions
This form contains 83 fields organized into 20 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Account Being Transferred Information | ||
| Account Being Transferred Number | Text |
Enter the account number of the account that is being transferred.
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| Account Being Transferred Owner Name(s) | Text |
Enter the name(s) of the account owner(s), trust, or entity for the account being transferred.
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| Transferring Firm Name | Text |
Enter the full legal name of the firm from which the account is being transferred.
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| Transferring Firm Street Address | Text |
Enter the street address of the firm from which the account is being transferred.
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| Transferring Firm City | Text |
Enter the city for the transferring firm's address.
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| Transferring Firm State/Province | Text |
Enter the state or province for the transferring firm's address.
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| Transferring Firm ZIP Code | Text |
Enter the ZIP or postal code for the transferring firm's address.
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| Delivering Firm Phone Number | Text |
Enter the phone number of the delivering firm.
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| Bank or Credit Union Account Transfer Instructions | ||
| 1. Transfer cash only | Checkbox |
Check this box to transfer all cash from the account, or specify a different amount to transfer.
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| Cash Transfer Amount | Number |
Enter the specific amount of cash to be transferred from the bank or credit union account.
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| 2. Liquidate CD immediately and send cash | Checkbox |
Check this box to immediately liquidate the Certificate of Deposit (CD) and send the cash, acknowledging a possible early withdrawal penalty.
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| 3. Liquidate CD at maturity and send cash | Checkbox |
Check this box to liquidate the Certificate of Deposit (CD) at its maturity date and send the cash, ensuring the request is submitted between 21 and 60 days before maturity.
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| CD Maturity Date | Date |
Provide the maturity date of the Certificate of Deposit (CD).
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| Brokerage or Trust Company Transfer Method | ||
| 1. Transfer the entire account | Checkbox |
Check this box if you wish to transfer all assets from your brokerage or trust company account.
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| 2. Transfer only part of my account in kind | Checkbox |
Check this box if you wish to transfer only specific assets from your brokerage or trust company account, and you will detail them below.
|
| Fidelity Account Information | ||
| Fidelity Account Number | Text |
Enter the account number for your Fidelity account.
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| New Fidelity account | Checkbox |
Check this box if you are opening a new Fidelity account and will attach a completed new account application.
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| Fidelity Account Owner/Trust/Entity Name | Text |
Provide the name of the primary owner, trust, or entity for the Fidelity account.
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| Fidelity Account SSN/Taxpayer ID Number | Text |
Enter the Social Security Number or Taxpayer ID Number for the primary Fidelity account owner.
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| Fidelity Additional Account Owner/Trust/Entity Name | Text |
Provide the name of any additional owner, trust, or entity for the Fidelity account.
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| Fidelity Additional Account SSN/Taxpayer ID Number | Text |
Enter the Social Security Number or Taxpayer ID Number for the additional Fidelity account owner.
|
| Fidelity Account Type | ||
| Individual | Checkbox |
Check this box if the Fidelity account is an individual nonretirement account.
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| Joint | Checkbox |
Check this box if the Fidelity account is a joint nonretirement account.
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| Trust | Checkbox |
Check this box if the Fidelity account is a nonretirement trust account.
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| Corp/Business | Checkbox |
Check this box if the Fidelity account is a corporate or business nonretirement account.
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| UGMA/UTMA | Checkbox |
Check this box if the Fidelity account is a Uniform Gifts to Minors Act (UGMA) or Uniform Transfers to Minors Act (UTMA) nonretirement account.
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| Estate | Checkbox |
Check this box if the Fidelity account is an estate nonretirement account.
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| Traditional, SEP, or Rollover IRA | Checkbox |
Check this box if the Fidelity account is a Traditional, SEP, or Rollover IRA retirement account.
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| Roth IRA | Checkbox |
Check this box if the Fidelity account is a Roth IRA retirement account.
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| SIMPLE IRA | Checkbox |
Check this box if the Fidelity account is a SIMPLE IRA retirement account.
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| Inherited IRA | Checkbox |
Check this box if the Fidelity account is an Inherited IRA retirement account.
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| Inherited Roth IRA | Checkbox |
Check this box if the Fidelity account is an Inherited Roth IRA retirement account.
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| Other For example, HSA | Checkbox |
Check this box if the Fidelity account is another type of nonretirement account, such as an HSA.
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| 1st Other Account Type | Text |
Specify the type of account if it falls under the 'Other' category for Fidelity Account Type.
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| First Brokerage Account Asset Detail | ||
| First Security Name, Symbol, or Cash | Text |
Please provide the security name, symbol, or type 'Cash' for the first asset being transferred.
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| First Number of Shares or All | Text |
Please provide the number of shares or type 'All' for the first asset being transferred.
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| First Mutual Fund Transfer Detail | ||
| First Fund Name/Symbol and Account Number | Text |
Enter the fund's name or symbol and its associated account number for the first mutual fund transfer.
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| First Number of Shares or All | Text |
Enter the number of shares to be transferred or type 'All' for the first mutual fund transfer.
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| First In Kind | Checkbox |
Check this box if you want the first mutual fund to be transferred as an 'In Kind' asset, meaning the shares themselves are transferred without being sold.
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| First Liquidate | Checkbox |
Check this box if you want the first mutual fund to be liquidated (sold) and the resulting cash transferred.
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| First Owner Name | ||
| First Owner Name | Text |
Enter the full name of the first owner, including their first name, middle initial (if applicable), and last name.
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| Full Annuity Surrender | ||
| 1. Full Annuity Surrender | Checkbox |
Check this box to transfer the entire annuity amount in cash immediately.
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| Full Annuity Surrender Date | ||
| 2. Full Annuity Surrender on This Date | Checkbox |
Check this box if you want to surrender the full annuity on a specific date.
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| Full Annuity Surrender Date | Date |
Provide the date on which the full annuity surrender will occur.
|
| General | ||
| Button | ||
| Reset | Button | |
| Save | Button | |
| Partial Annuity Surrender | ||
| 3. Partial Annuity Surrender | Checkbox |
Check this box if you want to partially surrender your annuity by transferring a specific cash amount.
|
| Partial Annuity Surrender Required Cash Amount | Number |
Provide the cash amount required for the partial annuity surrender.
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| Partial Annuity Surrender Penalty-Free Portion | ||
| 4. Partial Annuity Surrender - Penalty-Free Portion | Checkbox |
Check this box to transfer only the penalty-free portion of your annuity.
|
| Penalty-Free Approximate Cash Amount | Number |
Enter the approximate cash amount for the penalty-free portion of the partial annuity surrender.
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| Second Brokerage Account Asset Detail | ||
| Second Brokerage Account Asset Security Name | Text |
Provide the security name, symbol, or 'Cash' for the second brokerage account asset.
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| Second Brokerage Account Asset Number of Shares | Text |
Enter the number of shares or 'All' for the second brokerage account asset.
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| Second Mutual Fund Transfer Detail | ||
| Second Mutual Fund Name Symbol or Account Number | Text |
Enter the name, symbol, or account number for the second mutual fund to be transferred.
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| Second Mutual Fund Number of Shares or All | Text |
Enter the number of shares for the second mutual fund, or type 'All' to transfer all shares.
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| Second Mutual Fund In Kind | Checkbox |
Check this box if you want to transfer the second mutual fund as shares, without selling it.
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| Second Mutual Fund Liquidate | Checkbox |
Check this box if you want to sell the second mutual fund and transfer the cash proceeds.
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| Second Owner Name | ||
| Second Owner Printed Name | Text |
Enter the full printed name of the second owner (First, Middle Initial, Last).
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| Third Brokerage Account Asset Detail | ||
| Third Asset Security Name or Cash | Text |
Enter the security name, symbol, or indicate 'Cash' for the third asset to be partially transferred.
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| Third Asset Number of Shares or All | Text |
Enter the number of shares for the third asset, or type 'All' to transfer all shares.
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| Third Mutual Fund Transfer Detail | ||
| Third Fund Name, Symbol, and Account Number | Text |
Provide the name, symbol, and account number for the third mutual fund in this transfer.
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| Third Number of Shares or All | Text |
Specify the number of shares or enter 'All' for the third mutual fund in this transfer.
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| Third In Kind | Checkbox |
Check this box if you want to transfer the mutual fund shares as they are (in kind) from the mutual fund company.
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| Third Liquidate | Checkbox |
Check this box if you want to sell the mutual fund shares and transfer the cash proceeds.
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| Transfer Agent Transfer | ||
| Security Symbol or Name | Text |
Enter the security symbol or name for the transfer agent transfer.
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| 1. Transfer all whole shares and sell fractions | Checkbox |
Check this box to transfer all whole shares and sell any fractional shares.
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| 2. Transfer all whole shares only | Checkbox |
Check this box to transfer only whole shares, without selling any fractional shares.
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| 3. Transfer all whole shares, sell fractions, and close account | Checkbox |
Check this box to transfer all whole shares, sell fractional shares, and close the associated account.
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| 4. Transfer a specific number of whole shares | Checkbox |
Check this box to transfer a specific, indicated number of whole shares.
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| Number of Shares | Number |
Enter the number of whole shares to transfer.
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| Transferring Firm Account Type | ||
| Individual | Checkbox |
Check this box if the transferring firm account is an Individual account.
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| Joint | Checkbox |
Check this box if the transferring firm account is a Joint account.
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| Trust | Checkbox |
Check this box if the transferring firm account is a Trust account.
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| Corp/Business | Checkbox |
Check this box if the transferring firm account is a Corporate or Business account.
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| UGMA/UTMA | Checkbox |
Check this box if the transferring firm account is a Uniform Gifts to Minors Act (UGMA) or Uniform Transfers to Minors Act (UTMA) account.
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| Estate | Checkbox |
Check this box if the transferring firm account is an Estate account.
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| Traditional, SEP, or Rollover IRA | Checkbox |
Check this box if the transferring firm account is a Traditional IRA, Simplified Employee Pension (SEP) IRA, or Rollover IRA.
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| Roth IRA | Checkbox |
Check this box if the transferring firm account is a Roth IRA.
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| SIMPLE IRA | Checkbox |
Check this box if the transferring firm account is a Savings Incentive Match Plan for Employees (SIMPLE) IRA.
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| Inherited IRA | Checkbox |
Check this box if the transferring firm account is an Inherited IRA.
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| Inherited Roth IRA | Checkbox |
Check this box if the transferring firm account is an Inherited Roth IRA.
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| Other (e.g., HSA) | Checkbox |
Check this box if the transferring firm account type is not listed and requires specification, such as a Health Savings Account (HSA).
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| Transferring Firm Other Account Type | Text |
Provide the name of the transferring firm's other account type (e.g., HSA) if not listed above.
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