Rollover Request — 529 College Savings Plan Instructions

Provide the full name of the beneficiary.

Enter the Social Security Number or Taxpayer ID Number for the beneficiary.

Enter the full name of the beneficiary student.

Enter the Social Security Number or Taxpayer Identification Number of the beneficiary student.

Enter the date of birth of the beneficiary student.

Enter the full name of the contact person.

Enter the daytime phone number for the transferring firm contact.

Enter the extension for the daytime phone number.

Enter the account number of the Fidelity 529 plan account to be rolled over.

Enter the full name of the beneficiary associated with the Fidelity 529 plan account to be rolled over, ensuring it matches the beneficiary named in Section 1.

Enter the name or identifier of the first portfolio to be liquidated.

Provide the dollar amount to be liquidated from the first portfolio.

Check this box to liquidate all of the First Portfolio, rather than specifying a particular dollar amount.

Enter the name of the first portfolio to be listed for rollover.

Enter the dollar amount for the first portfolio to be rolled over.

Check this box to transfer all funds from the first listed portfolio instead of specifying a dollar amount for the partial rollover.

Enter the name or identifier for the fourth portfolio to be liquidated.

Enter the dollar amount to be liquidated from the fourth portfolio.

Check this box if you want to liquidate and transfer the entire Fourth Portfolio instead of specifying a dollar amount.

Enter the name of the fourth portfolio to be transferred.

Enter the dollar amount to be transferred from the fourth portfolio.

Check this box to indicate that all funds from the fourth portfolio listed should be transferred.

Please enter the printed name of the first owner or authorized individual.

Please enter the printed name of the second owner or authorized individual.

Provide the Fidelity 529 account number for the participant, owner, or authorized individual.

Enter the full name of the participant, owner, or authorized individual.

Provide the Social Security Number (SSN) or Taxpayer Identification Number (TIN) for the participant, owner, or authorized individual.

Enter the primary phone number for the participant, owner, or authorized individual.

Please provide the full name of the participant or trustee.

Please provide the Social Security number or Taxpayer ID number for the participant or trustee.

Check this box to perform a full rollover of the account, which is the default if no other information is indicated below, and then skip to Section 5.

Check this box to perform a partial rollover, transferring only the amount specified in the fields below.

Check this box if the rollover is from a Coverdell education savings account and you will provide an account statement issued by the financial institution showing basis and earnings.

Check this box if the rollover is from the redemption of qualified U.S. Savings Bonds and you will provide an account statement or Form 1099-INT showing interest from the redemption of the bonds.

Check this box if the rollover is from another 529 Plan and you will provide a statement issued by the distributing 529 program showing the earnings portion of the distribution.

Enter the name or identifier of the second portfolio to be liquidated.

Enter the dollar amount to be liquidated from the second portfolio.

Check this box to liquidate and transfer all funds from the second listed portfolio, rather than a specific dollar amount.

Enter the name of the second portfolio you wish to list.

Enter the dollar amount for the second portfolio.

Check this box to transfer all funds from the second listed portfolio, rather than a specific dollar amount.

Provide the name or identifier of the third portfolio to be liquidated.

Enter the dollar amount to be liquidated from the third portfolio.

Check this box if you want to liquidate and transfer the entire amount for the third listed portfolio, rather than a specific dollar amount.

Enter the name of the third portfolio to list for rollover.

Enter the dollar amount to transfer from the third portfolio.

Check this box if you want to transfer the entire amount of the third listed portfolio.

Provide the total dollar amount.

Provide the total dollar amount.

Check this box if you want to liquidate and transfer your entire account.

Check this box if you want to liquidate and transfer only a part of your account.

Provide the 529 account number you are requesting to transfer.

Enter the first line of the transferring firm's street address.

Enter the city of the transferring firm's address.

Enter the state of the transferring firm's address.

Enter the ZIP Code of the transferring firm's address.

Enter the name of the firm from which assets are being transferred.

Enter the name of the trust, if applicable.

Enter the Social Security Number or Taxpayer ID Number for the trust, if applicable.

Check this box if the 529 account you are requesting to transfer to Fidelity is an individual 529 account.

Check this box if the 529 account you are requesting to transfer to Fidelity is a joint 529 account.

Check this box if the 529 account you are requesting to transfer to Fidelity is a trust 529 account.

Check this box if the 529 account you are requesting to transfer to Fidelity is a UGMA/UTMA 529 account.

Check this box if the account you are requesting to transfer to Fidelity is a Coverdell education savings account.