This form contains 23 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Account Owner Information
Account Owner Fidelity Account Number 1	Text	Enter the first Fidelity account number for the account owner. Max length: 9 characters
Account Owner Fidelity Account Number 2	Text	Enter the second Fidelity account number for the account owner, if applicable. Max length: 9 characters
Account Owner Name	Text	Enter the full name of the account owner.
Account Owner Primary Phone	Text	Enter the primary phone number for the account owner. Max length: 10 characters
Ex-Spouse Information
Ex-Spouse Fidelity Account Number 1	Text	Enter the first Fidelity account number for the ex-spouse. Max length: 9 characters
Ex-Spouse Fidelity Account Number 2	Text	Enter the second Fidelity account number for the ex-spouse, if applicable. Max length: 9 characters
Ex-Spouse Name	Text	Enter the full name of the ex-spouse as it appears on the receiving account.
First Security to Transfer
First Security Investment Name	Text	Enter the name of the first security to be transferred.
First Security CUSIP or Symbol	Text	Enter the CUSIP or trading symbol for the first security to be transferred. Max length: 9 characters
First Security Number of Shares	Text	Enter the number of shares to be transferred for the first security, or indicate 'ALL' for a full transfer. Max length: 12 characters
First Security ALL	Checkbox	Check this box if you wish to transfer all shares of the first security listed.
General
Print	Button
Reset	Button
Save	Button
Second Security to Transfer
Second Security Investment Name	Text	Enter the name of the second security to be transferred.
Second Security CUSIP or Symbol	Text	Provide the CUSIP or ticker symbol for the second security to be transferred. Max length: 9 characters
Second Security Number of Shares	Number	Enter the number of shares for the second security to be transferred. Max length: 12 characters
Second Security ALL Shares	Checkbox	Check this box to transfer all shares of the second security listed.
Securities Transfer Selection
Security 1 ALL	Checkbox	Check this box to transfer all shares of the first security listed for in-kind transfer.
Transfer Instructions
1 Specified Amount	Checkbox	Check this box if you wish to transfer a specific dollar amount, which must be available in the core position or in a cash position in a Mutual Fund Only account.
Specified Dollar Amount	Number	Enter the specific dollar amount to be transferred, which must be available in the core position or a cash position in a Mutual Fund Only account. Max length: 8 characters
2 Specified Percentage of entire account	Checkbox	Check this box if you wish to transfer a specific percentage of the entire account.
Specified Percentage	Number	Enter the percentage of the entire account to be transferred.

Transfer Due to Divorce — IRA/HSA/529 Instructions