Irrevocable Contribution Form and Letter of Instruction Instructions
This form contains 128 fields organized into 49 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Asset Allocation 20% Equity | ||
| Asset Allocation 20% Equity | Checkbox |
Check this box if you want to select an asset allocation pool with 20% equity for instant diversification across multiple asset classes.
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| Asset Allocation 20% Equity | Number |
Enter the percentage for the Asset Allocation 20% Equity pool.
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| Asset Allocation 30% Equity | ||
| Asset Allocation 30% Equity | Checkbox |
Check this box if you want to allocate 30% equity for instant diversification to multiple asset classes in a single investment.
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| Asset Allocation 30% Equity Percentage | Number |
Enter the percentage of the contribution to be allocated to the Asset Allocation 30% Equity pool.
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| Asset Allocation 40% Equity | ||
| Asset Allocation 40% Equity | Checkbox |
Check this box to allocate funds to the Asset Allocation 40% Equity pool, which offers instant diversification to multiple asset classes with 40% equity.
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| Asset Allocation 40% Equity Percentage | Number |
Enter the percentage of the total investment to be allocated to the Asset Allocation 40% Equity pool.
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| Asset Allocation 50% Equity | ||
| Asset Allocation 50% Equity | Checkbox |
Check this box if you want to allocate your investment to the Asset Allocation 50% Equity pool, which is designed for instant diversification.
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| Asset Allocation 50% Equity Percentage | Number |
Enter the percentage of the total allocation for Asset Allocation 50% Equity.
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| Asset Allocation 60% Equity | ||
| Asset Allocation 60% Equity | Checkbox |
Check this box if you want to allocate your irrevocable contribution to the Asset Allocation 60% Equity pool.
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| Asset Allocation 60% Equity Percentage | Number |
Enter the percentage of the total investment to be allocated to Asset Allocation 60% Equity.
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| Asset Allocation 70% Equity | ||
| Asset Allocation 70% Equity | Checkbox |
Check this box if you want to allocate your contribution to the Asset Allocation 70% Equity pool.
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| Asset Allocation 70% Equity Percentage | Number |
Enter the percentage to be allocated for the Asset Allocation 70% Equity investment pool.
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| Asset Allocation 85% Equity | ||
| Asset Allocation 85% Equity | Checkbox |
Check this box if you want to allocate your contribution to the Asset Allocation 85% Equity pool.
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| Asset Allocation 85% Equity Percentage | Number |
Enter the percentage of the total contribution to allocate to the 85% Equity asset pool.
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| Cash Contribution Details | ||
| Contribute cash held at Fidelity | Checkbox |
Check this box if you are making a cash contribution that is held at Fidelity.
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| Cash Contribution Amount | Number |
Provide the amount of cash to be transferred for the contribution.
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| Fidelity Account Number | Text |
Enter the Fidelity account number from which the cash will be contributed.
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| Charitable Legacy Pool Allocation | ||
| Option 1 Charitable Legacy | Checkbox |
Check this box if you are a donor seeking an 'all-weather' asset allocation pool with exposure to both traditional and non-traditional asset classes.
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| Charitable Legacy Percentage | Number |
Enter the percentage of the total contribution to be allocated to the Charitable Legacy Pool.
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| Check Amount | ||
| Check Amount | Number |
Provide the total amount of the check.
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| Citizenship Status | ||
| 1 U.S. citizen | Checkbox |
Check this box if the individual is a U.S. citizen.
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| 2 U.S. resident alien | Checkbox |
Check this box if the individual is a U.S. resident alien.
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| Contact Information | ||
| Preferred Phone | Text |
Please enter your preferred phone number for contact.
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| Address | Text |
Please provide your full street address.
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| City | Text |
Please enter the city of your residence.
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| State or Province | Text |
Please enter your state or province.
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| ZIP or Postal Code | Text |
Please enter your ZIP or postal code.
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| Country | Text |
Please enter your country of residence.
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| Contribution Allocation Method | ||
| 1. Allocate in same percentages as current pools | Checkbox |
Check this box if you want to allocate your irrevocable contribution using the same percentages as your existing investment pools.
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| 2. Allocate as follows | Checkbox |
Check this box if you want to manually specify the allocation method for your irrevocable contribution using the options provided below.
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| Contribution Type | ||
| Assets held at Fidelity Investments | Checkbox |
Check this box if the assets you are contributing are currently held at Fidelity Investments.
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| Assets held outside of Fidelity Investments | Checkbox |
Check this box if the assets you are contributing are currently held outside of Fidelity Investments.
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| Checks, wires, or stock certificates | Checkbox |
Check this box if your contribution consists of checks, wires, or stock certificates.
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| Restricted Stock or Non-Publicly Traded Assets | Checkbox |
Check this box if you intend to contribute restricted stock, stock from a Dividend Reinvestment Plan (DRIP), or other non-publicly traded assets, and note that you will need to contact Fidelity Charitable for this type of contribution.
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| Delivering Firm Information | ||
| Delivering Firm Name | Text |
Enter the full legal name of the firm delivering the assets.
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| Advisor/Broker Name | Text |
Enter the name of the advisor or broker associated with the delivering firm.
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| Preferred Phone | Text |
Enter the preferred phone number for the delivering firm or advisor.
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| Phone Extension | Text |
Enter the phone extension for the preferred phone number, if applicable.
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| Address | Text |
Enter the street address of the delivering firm.
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| City | Text |
Enter the city of the delivering firm's address.
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| State/Province | Text |
Enter the state or province of the delivering firm's address.
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| ZIP/Postal Code | Text |
Enter the ZIP or postal code of the delivering firm's address.
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| Country | Text |
Enter the country of the delivering firm's address.
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| Account Number at Delivering Firm | Text |
Enter the account number held at the delivering firm from which assets are being transferred.
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| Donor Name | ||
| Donor First Name | Text |
Please enter the first name of the donor.
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| Donor Middle Initial | Text |
Please enter the middle initial of the donor.
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| Donor Last Name | Text |
Please enter the last name of the donor.
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| Donor Type | ||
| Account Holder | Checkbox |
Check this box if the contribution is being made by the Fidelity Charitable Giving Account holder.
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| Third-Party Donor | Checkbox |
Check this box if the contribution is being made by someone other than the Fidelity Charitable Giving Account holder.
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| Entity Information | ||
| Entity | Checkbox |
Check this box if the irrevocable contribution is being made by an entity, such as a trust, partnership, or corporation.
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| Entity Legal Name | Text |
Provide the legal name of the entity, such as a trust, partnership, or corporation, that is making this irrevocable contribution.
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| Environmental Impact Access Allocation | ||
| Environmental Impact Access | Checkbox |
Check this box if you are a donor seeking strategies that consider social and environmental factors, while emphasizing financial returns, and wish to allocate to Environmental Impact Access within the Sustainable and Impact Investing Pools.
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| Environmental Impact Access Percentage | Number |
Enter the percentage of funds to be allocated to Environmental Impact Access.
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| Fidelity Charitable Giving Account Number | ||
| Fidelity Charitable Giving Account Number | Text |
Enter the Fidelity Charitable Giving Account Number.
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| First Asset for Transfer | ||
| First Asset Number of Shares | Number |
Enter the number of shares for the first asset to be transferred.
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| First Asset Approximate Dollar Amount | Number |
Enter the approximate dollar amount for the first asset, if known.
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| First Asset Description of Security | Text |
Provide a description of the first asset or the name of the security being transferred.
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| First Asset Lot Acquisition Date | Text |
Enter the acquisition date for this lot of the first asset, in MM DD YYYY format, if optional.
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| First Asset Lot Acquisition Cost | Number |
Enter the acquisition cost for this lot of the first asset, if optional.
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| First Asset Security Symbol | Text |
Enter the security symbol for the first asset.
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| First Security Contribution | ||
| First Security Description of Assets | Text |
Provide a description of the first security asset being contributed.
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| First Security Symbol | Text |
Enter the ticker symbol for the first security asset.
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| First Security Fidelity Account Number | Text |
Enter the Fidelity account number associated with the first security asset.
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| First Security Number of Shares | Number |
Specify the number of shares for the first security asset being contributed.
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| First Security Lot Acquisition Date | Date |
Provide the acquisition date of the lot for the first security asset, if applicable.
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| First Security Lot Acquisition Cost | Number |
Enter the acquisition cost of the lot for the first security asset, if applicable.
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| First Stock Certificate | ||
| First Stock Certificate Name | Text |
Enter the name of the stock for the first certificate.
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| First Stock Certificate Number of Shares | Number |
Enter the number of shares for the first stock certificate.
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| Fixed Income Access Allocation | ||
| Fixed Income Access | Checkbox |
Check this box to include Fixed Income Access as part of your custom investment strategy within the Bond category.
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| Fixed Income Access Allocation | Number |
Enter the percentage for Fixed Income Access allocation.
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| Fixed Income Allocation | ||
| Fixed Income | Checkbox |
Check this box to allocate contributions to Fixed Income within your bond investment selection.
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| Fixed Income Percentage | Number |
Enter the percentage of the total allocation for Fixed Income.
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| General | ||
| Button | ||
| Reset | Button | |
| Save | Button | |
| Giving Account Details | ||
| Giving Account Number | Text |
Provide the unique identification number for the giving account.
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| Giving Account Name | Text |
Enter the name of the giving account.
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| Inflation Protected Bond Index Allocation | ||
| Inflation Protected Bond Index | Checkbox |
Check this box to allocate funds to the Inflation Protected Bond Index.
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| Inflation Protected Bond Index Percentage | Number |
Enter the percentage of the total investment to be allocated to the Inflation Protected Bond Index.
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| International Equity Access Allocation | ||
| International Equity Access | Checkbox |
Check this box if you wish to allocate funds to International Equity Access as part of a custom investment strategy for your Giving Account balance.
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| International Equity Access Allocation | Number |
Enter the percentage of assets to be allocated to International Equity Access.
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| International Equity Allocation | ||
| International Equity | Checkbox |
Check this box if you wish to allocate funds to International Equity within the Foreign Stock category of single asset class pools.
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| International Equity Allocation Percentage | Number |
Enter the percentage of funds to be allocated to International Equity.
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| International Index Allocation | ||
| International Index | Checkbox |
Check this box if you want to allocate funds to an International Index foreign stock as part of your custom asset class pool strategy.
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| International Index Allocation | Number |
Provide the percentage of the investment to be allocated to the International Index.
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| Managed Account Number | ||
| Managed Account Number | Checkbox |
Check this box if you are providing a managed account number for your contribution to be transferred to the managed account as part of the Charitable Investment Advisor Program (CIAP).
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| Managed Account Number | Text |
Please enter the managed account number.
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| Money Market Allocation | ||
| Money Market | Checkbox |
Check this box if you want to allocate funds to the Money Market asset class within Option 4: Single Asset Class Pools.
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| Money Market Percentage | Number |
Enter the percentage of allocation for Money Market investments.
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| Page 5 | ||
| Donor or Authorized Party Name | Text |
Enter the name of the donor or authorized party.
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| Additional Signatory Name | Text |
Enter the name of the additional signatory, if dual signatures are required by the firm.
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| Second Asset for Transfer | ||
| Second Asset Number of Shares | Number |
Enter the number of shares for the second asset being transferred.
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| Second Asset Approximate Dollar Amount | Number |
Enter the approximate dollar amount of the second asset being transferred, if known.
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| Second Asset Description of Assets/Security Name | Text |
Provide a description of the second asset or the name of the security being transferred.
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| Second Asset Lot Acquisition Date | Date |
Enter the acquisition date for the lot of the second asset being transferred.
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| Second Asset Lot Acquisition Cost | Number |
Enter the acquisition cost for the lot of the second asset being transferred, if known.
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| Second Asset Symbol | Text |
Enter the ticker symbol for the second asset being transferred, if applicable.
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| Second Security Contribution | ||
| Second Security Description of Assets | Text |
Enter a description of the second security, stock, or mutual fund being contributed.
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| Second Security Symbol | Text |
Enter the ticker symbol for the second security, stock, or mutual fund being contributed.
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| Second Security Fidelity Account Number | Text |
Enter the Fidelity Account Number associated with the second security being contributed.
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| Second Security Number of Shares | Number |
Enter the total number of shares for the second security being contributed.
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| Second Security Lot Acquisition Date | Date |
Enter the optional acquisition date for the lot of the second security being contributed.
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| Second Security Lot Acquisition Cost | Number |
Enter the optional acquisition cost for the lot of the second security being contributed.
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| Second Stock Certificate | ||
| Second Stock Certificate Name | Text |
Enter the name of the second stock certificate.
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| Second Stock Certificate Number of Shares | Number |
Enter the total number of shares for the second stock certificate.
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| Short-Term Fixed Income Access Allocation | ||
| Short-Term Fixed Income Access | Checkbox |
Check this box if you want to allocate funds to Short-Term Fixed Income Access as part of your investment strategy.
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| Short-Term Fixed Income Access Percentage | Number |
Enter the percentage of allocation for Short-Term Fixed Income Access.
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| Sustainable International Index Allocation | ||
| Sustainable International Index | Checkbox |
Check this box to allocate funds to the Sustainable International Index stock investment option, which considers social and environmental factors while emphasizing financial returns.
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| Sustainable International Index Percentage | Number |
Enter the percentage of the total allocation to be invested in the Sustainable International Index.
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| Sustainable U.S. Bond Index Allocation | ||
| Sustainable U.S. Bond Index | Checkbox |
Check this box if you want to allocate funds to a Sustainable U.S. Bond Index as part of a sustainable and impact investing strategy.
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| Sustainable U.S. Bond Index Percentage | Number |
Enter the percentage of the total allocation for the Sustainable U.S. Bond Index.
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| Sustainable U.S. Index Access Allocation | ||
| Sustainable U.S. Index Access | Checkbox |
Check this box to allocate funds to the Sustainable U.S. Index Access pool as part of your investment selection.
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| Sustainable U.S. Index Access Percentage | Number |
Please provide the percentage allocation for the Sustainable U.S. Index Access.
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| Sustainable U.S. Index Allocation | ||
| Sustainable U.S. Index | Checkbox |
Check this box to allocate funds to the Sustainable U.S. Index as part of the Sustainable and Impact Investing Pools.
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| Sustainable U.S. Index Allocation | Number |
Enter the percentage of the total allocation for the Sustainable U.S. Index.
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| Tax Identification Number | ||
| Tax Identification Number | Text |
Enter the Social Security Number or Tax Identification Number.
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| Total Market Index Allocation | ||
| Total Market Index | Checkbox |
Select this option to allocate your contribution to the Total Market Index within the Single Asset Class Pools.
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| Total Market Index Allocation Percentage | Number |
Enter the percentage of allocation for Total Market Index.
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| Transfer Initiation Options | ||
| Option 1: I Will Initiate Transfer | Checkbox |
Check this box if you will personally initiate the transfer of assets by completing the required steps, which involves contacting the financial institution directly for procedures and forms.
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| Option 2: I Authorize Fidelity Charitable | Checkbox |
Check this box if you authorize Fidelity Charitable to initiate the transfer of assets on your behalf by completing this form and submitting it to them, especially when transferring mutual funds.
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| U.S. Bond Index Allocation | ||
| U.S. Bond Index | Checkbox |
Check this box if you want to allocate funds to the U.S. Bond Index.
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| U.S. Bond Index Allocation | Number |
Enter the percentage allocation for the U.S. Bond Index.
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| U.S. Equity Access Allocation | ||
| U.S. Equity Access | Checkbox |
Check this box to include the U.S. Equity Access fund in your single asset class allocation strategy.
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| U.S. Equity Access Allocation Percentage | Number |
Enter the percentage of allocation for U.S. Equity Access.
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| U.S. Equity Allocation | ||
| U.S. Equity | Checkbox |
Check this box to allocate funds to U.S. Equity as part of a custom single asset class strategy.
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| U.S. Equity Percentage | Number |
Provide the percentage of the total allocation for U.S. Equity.
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| Wire Transfer Details | ||
| Wire Transfer Amount | Number |
Please enter the amount of the wire transfer.
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| Wire Transfer Bank Name | Text |
Please enter the name of the bank from which the wire transfer will be initiated.
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