This form contains 76 fields organized into 29 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
529 Beneficiary Information
529 Beneficiary Name Text
Provide the full name of the 529 beneficiary.
529 Beneficiary Social Security or Taxpayer ID Number Text
Provide the Social Security Number or Taxpayer Identification Number for the 529 beneficiary.
Max length: 9 characters
529 Participant Information
529 Participant Name Text
Provide the full name of the 529 participant.
529 Participant Social Security or Taxpayer ID Number Text
Provide the Social Security or Taxpayer Identification Number for the 529 participant.
Max length: 9 characters
60-Day Rollover Selection
60-Day Rollover from a non-Fidelity ABLE account Checkbox
Check this box if you are performing a 60-day rollover from a non-Fidelity ABLE account.
60-Day Rollover from a non-Fidelity 529 account Checkbox
Check this box if you are performing a 60-day rollover from a non-Fidelity 529 account.
Account Type
Individual Checkbox
Check this box if the 529 account you are requesting to transfer is an Individual account.
Joint Checkbox
Check this box if the 529 account you are requesting to transfer is a Joint account.
Other Checkbox
Check this box if the 529 account you are requesting to transfer is an account type other than Individual or Joint.
Beneficiary Relationship
Beneficiary Relationship Text
Please provide the relationship of the 529 beneficiary to the ABLE Designated Beneficiary or Eligible Individual.
Daytime Phone
Daytime Phone Text
Please provide your daytime phone number.
Max length: 10 characters
Extension Text
Please provide the extension for the daytime phone number, if applicable.
Max length: 4 characters
Daytime Phone Text
Please provide the daytime phone number for the contact person.
Max length: 10 characters
Extension Text
Please provide the phone extension for the contact person, if applicable.
Max length: 4 characters
Designated Beneficiary Information
Designated Beneficiary Name Text
Provide the full name of the designated beneficiary or eligible individual.
Designated Beneficiary SSN or Taxpayer ID Number Text
Provide the Social Security Number or Taxpayer ID Number for the designated beneficiary or eligible individual.
Max length: 9 characters
Designated Beneficiary/Eligible Individual Information
Designated Beneficiary/Eligible Individual Name Text
Enter the full name of the designated beneficiary or eligible individual.
Designated Beneficiary/Eligible Individual Social Security or Taxpayer ID Number Text
Enter the Social Security Number or Taxpayer Identification Number of the designated beneficiary or eligible individual.
Max length: 9 characters
Fidelity 529 Account Information
Fidelity 529 Account Number Text
Provide the Fidelity 529 account number.
Max length: 9 characters
529 Beneficiary Name Text
Provide the name of the 529 beneficiary.
Fidelity Account Number
Fidelity Account Number Text
Enter the Fidelity account number.
Max length: 9 characters
First Portfolio Liquidation Details
First Portfolio Name Text
Enter the name of the first portfolio to be liquidated.
First Portfolio Dollar Amount Number
Enter the dollar amount to be liquidated from the first portfolio.
Max length: 9 characters
First Portfolio Full Distribution Checkbox
Check this box if the specified dollar amount for the first portfolio represents a full distribution of that particular portfolio.
First Portfolio Rollover
First Portfolio Name Text
Enter the name of the first portfolio from which assets are being rolled over.
First Portfolio Dollar Amount Number
Enter the dollar amount to be rolled over from the first portfolio.
First Portfolio ALL Checkbox
Check this box to roll over all assets from the first specified portfolio entry, instead of a specific dollar amount.
Fourth Portfolio Liquidation Details
Fourth Portfolio Name Text
Enter the name of the fourth portfolio to be liquidated.
Fourth Portfolio Dollar Amount Number
Enter the dollar amount for the fourth portfolio to be liquidated.
Max length: 9 characters
Fourth Full Portfolio Distribution Checkbox
Check this box to indicate that the entire fourth portfolio should be distributed, rather than a specific dollar amount.
General
Print Button
Reset Button
Save Button
Joint 529 Participant Information
Joint 529 Participant 1 Name Text
Enter the full name of the first joint 529 participant.
Joint 529 Participant 1 SSN or TIN Text
Enter the Social Security Number or Taxpayer Identification Number for the first joint 529 participant.
Max length: 9 characters
Page 5
6a. PSA or Designated Beneficiary/Eligible Individual Name Text
Please enter the printed full name of the PSA or Designated Beneficiary/Eligible Individual for section 6a.
6b. Print Participant Name Text
Please enter the printed full name of the 529 Participant for section 6b.
Page 6
Participant Name Text
Please provide the full name of the participant for printing in the signature section.
Partial Liquidation Total Amount
Total Amount Number
Enter the total amount for the partial liquidation.
Max length: 9 characters
Person with Signature Authority (PSA) Information
PSA Name Text
Enter the full name of the person with signature authority (PSA).
PSA Social Security or Taxpayer ID Number Text
Enter the Social Security Number (SSN) or Taxpayer Identification Number (TIN) for the person with signature authority (PSA).
Max length: 9 characters
Rollover Amount Selection
Rollover Amount Selection 1: ALL assets in this account Checkbox
Check this box if you want to roll over all assets from this Fidelity 529 account to the ABLE account.
Rollover Amount Selection 2: ONLY the following amount(s) Checkbox
Check this box if you want to roll over only specific amounts from designated portfolios within this account, which must be specified in the fields below.
Second Portfolio Liquidation Details
Second Portfolio Name Text
Enter the name of the second portfolio to be liquidated.
Second Portfolio Dollar Amount Number
Enter the dollar amount to be liquidated from the second portfolio.
Max length: 9 characters
Second Full Portfolio Distribution Checkbox
Check this box if you want to liquidate and transfer the entire second listed portfolio.
Second Portfolio Rollover
Second Portfolio Name Text
Provide the name of the second portfolio you wish to roll over.
Second Portfolio Dollar Amount Number
Enter the dollar amount from the second portfolio you wish to roll over.
Second Portfolio ALL Checkbox
Check this box if you want to roll over ALL assets from the second portfolio listed, instead of specifying a dollar amount.
Signature Authority Person Information
Signature Authority Person Name Text
Enter the full name of the person with signature authority.
Signature Authority Person Social Security or Taxpayer ID Number Text
Provide the Social Security Number or Taxpayer Identification Number for the person with signature authority.
Max length: 9 characters
Third Portfolio Liquidation Details
Third Portfolio Name Text
Enter the name of the third portfolio being liquidated.
Third Portfolio Dollar Amount Number
Enter the dollar amount to be liquidated from the third portfolio.
Max length: 9 characters
Third Full Portfolio Distribution Checkbox
Check this box if you want to liquidate and transfer the full amount of the third listed portfolio.
Third Portfolio Rollover
Third Portfolio Name Text
Enter the name of the third portfolio from which assets are being rolled over.
Third Portfolio Dollar Amount Number
Enter the dollar amount to be rolled over from the third portfolio.
Third Portfolio ALL Checkbox
Check this box if you wish to roll over all assets from the third listed portfolio, instead of specifying a dollar amount.
Total Dollar Amount
Total Dollar Amount Number
Enter the total dollar amount for the rollover.
Transfer Instructions
Full Liquidation Checkbox
Check this box if you intend to liquidate and transfer your entire account.
Partial Liquidation Checkbox
Check this box if you intend to liquidate and transfer only a part of your account, providing details in the fields below.
Transferring Firm Address
Transferring Firm Street Address Text
Enter the street address of the transferring firm.
Transferring Firm City Text
Enter the city of the transferring firm.
Transferring Firm State Text
Enter the state of the transferring firm.
Max length: 2 characters
Transferring Firm ZIP Code Text
Enter the ZIP code of the transferring firm.
Transferring Firm Information
Transferring Account Number Text
Enter the account number of the transferring firm.
Transferring Firm Name Text
Enter the name of the transferring firm.
Transferring Firm Contact Person Text
Enter the name of the contact person for the transferring firm.
529 Account Number Text
Enter the 529 account number of the transferring firm.
Transferring Firm Name Text
Enter the full legal name of the transferring firm.
Contact Person Text
Enter the name of the contact person at the transferring firm.
Daytime Phone Text
Enter the daytime phone number of the contact person.
Max length: 10 characters
Phone Extension Text
Enter the phone extension for the contact person, if applicable.
Max length: 4 characters
Transferring Firm Street Address Text
Enter the street address of the transferring firm.
City Text
Enter the city of the transferring firm's address.
State Text
Enter the state of the transferring firm's address.
Max length: 2 characters
ZIP Code Text
Enter the ZIP code of the transferring firm's address.