/BOSTON/xinet/BosWork/Jobs/30242/PIECE13/25543 04 FRM 529Rollove 529 College Savings Plan Rollover Instructions
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Print Reset Save Questions? Go to Fidelity.com/college or call 800-544-1914. Rollover Request — 529 College Savings Plan Use this form to initiate a rollover or deposit of your 529 College Savings Plan, Coverdell education savings account, a qualified U.S. Savings Bond, or another 529 College Savings Plan (“529 plan”) to a 529 plan at Fidelity. Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information or signatures, make a copy of the relevant page. Helpful to Know •A ccording to IRS regulations, you are eligible to roll over from another 529 plan once every 12 months without changing the beneficiary. To be valid, a rollover from another 529 plan must be made within 60 days of the distribution from the other 529 plan. •Y our current 529 plan administrator may require specific forms or signatures to roll over your 529 plan assets to Fidelity. The administrator may also send you a rollover check directly. Check with your current 529 plan administrator to verify requirements. •S ubmit this form directly to Fidelity, not to the 529 plan administrator from which you are requesting the funds to be transferred. •D o NOT use this form to change the beneficiary on your 529 plan. To change the beneficiary, visit Fidelity.com to complete the transaction online or to obtain the correct form. You may not change the beneficiary on a custodial 529 plan. • If you have already received a check from your 529 plan, include it with this form. • If you do not have a check yet, Fidelity will contact the plan administrator and instruct it to liquidate and transfer the funds directly to us. Fidelity is not responsible for market fluctuation on requests with written liquidation instructions. •Y ou are responsible for providing Fidelity with the principal and earnings breakdown of the amount of this rollover. See Section 3 for documentation requirements. • Important: You must have an existing Fidelitymanaged 529 account prior to submitting this request. You can open a new account online at Fidelity.com/ openaccount, or complete a 529 College Savings new account application and submit it along with this form. If you are rolling over a UGMA/UTMA 529 plan, you must establish a Fidelity-managed UGMA/UTMA 529 plan account for the same beneficiary. 1. Fidelity-managed 529 Plan Information Participant (Owner)/Authorized Individual Fidelity 529 Account Number Name This phone number may be used if we have questions, but will not be used to update your account information. Beneficiary Social Security or Taxpayer ID Number Daytime Phone Student Information Name Social Security or Taxpayer ID Number Date of Birth MM DD YYYY Form continues on next page. 1.715310.115 Page 1 of 4 007980401 2. R ollover between Fidelity-managed 529 Plans Complete only if both accounts are held with Fidelity. Provide the account number of the account to be rolled over and the beneficiary name on that account. The name must match the beneficiary named in Section 1. Attach extra sheets for additional portfolio listings. Indicate at least one portfolio name. If the amount of your request is equal to or greater than your portfolio value, we will send only the available balance. Fidelity 529 Account Number 529 Beneficiary Name Full Rollover Default if no other information indicated below. Skip to Section 5. Partial Rollover — Transfer only this amount. Portfolio Dollar Amount $ Portfolio . OR ALL . OR ALL . OR ALL . OR ALL Dollar Amount $ Portfolio Dollar Amount $ Portfolio Dollar Amount $ Total Dollar Amount $ . 0 3. 60-Day Rollover from a 529 Plan Not Administered by Fidelity Complete only if you have received a check from your 529 plan to include with this form. Check the appropriate box as to the type of rollover, and provide the specified documentation so that your principal and earnings amounts are appropriately recorded. Until such time as Fidelity receives the specified documentation, we must, by law, treat the entire amount of the contribution as earnings in the 529 plan account receiving the distribution. R ollover from a Coverdell education savings account Provide an account statement issued by the financial institution that acted as trustee or custodian of the account, showing basis and earnings in the account. Rollover from the redemption of qualified U.S. Savings Bonds Provide an account statement or Form 1099-INT issued by the financial institution that redeemed the bonds, showing interest from the redemption of the bonds. Rollover from another 529 Plan Provide a statement issued by the distributing 529 program, showing the earnings portion of the distribution. Form continues on next page. 1.715310.115 Page 2 of 4 007980402 4. Transfer of Assets from a 529 Plan Not Administered by Fidelity Check the appropriate box as to the type of 529 plan account you are requesting to transfer to Fidelity. For an account owned by a trust, provide the trustee’s information. For an UGMA/UTMA account, provide the custodian’s information. Fidelity will request the additional required principal and earnings documentation from the current 529 plan administrator on your behalf during the transfer process. Transferring Account Information Check the type of 529 account you are requesting to transfer to Fidelity. Individual 529 Joint 529 Trust 529 UGMA/UTMA 529 Transferring 529 Account Number Participant/Trustee Name Social Security or Taxpayer ID Number Trust Name if applicable Social Security or Taxpayer ID Number Beneficiary Name Social Security or Taxpayer ID Number Transferring Firm Information Note: If you are requesting a transfer from a Coverdell education savings account, you may need to contact the transferring firm to request a liquidation. Transferring Firm Name Contact Person Daytime Phone Extension Transferring Firm Address City State ZIP Code Transfer Instructions Check only one. Full Liquidation — Liquidate and transfer my entire account. Skip to Section 5. Partial Liquidation — Liquidate and transfer only a part of my account, as detailed below: Attach extra sheets for additional portfolio listings. Portfolio Dollar Amount $ Portfolio . OR ALL . OR ALL . OR ALL . OR ALL Dollar Amount $ Portfolio Dollar Amount $ Portfolio Dollar Amount $ Total Dollar Amount $ . 0 Form continues on next page. 1.715310.115 Page 3 of 4 007980403 5. Signature All owners of both accounts must sign this form By signing below, you: •C ertify that you have read the Fact Kit and Participation Agreement. •U nderstand that IRS regulations allow one rollover per beneficiary during a 12-month period without changing the beneficiary. Otherwise, a change in beneficiary is required if a transaction is to be considered a rollover. All rollovers must be completed within 60 days of the time of distribution or from when the transfer leaves the account. MEDALLION SIGNATURE GUARANTEE PRINT OWNER/AUTHORIZED INDIVIDUAL NAME SIGN OWNER/AUTHORIZED INDIVIDUAL SIGNATURE X DAT E TODAY’S DATE MM/DD/YYYY X MEDALLION SIGNATURE GUARANTEE PRINT OWNER/AUTHORIZED INDIVIDUAL NAME SIGN OWNER/AUTHORIZED INDIVIDUAL SIGNATURE X D AT E TODAY’S DATE MM/DD/YYYY X Delivering Firm Use Only To the previous trustee or custodian: Please be advised that Fidelity Brokerage Services LLC has established a 529 account to receive the distribution from the 529 plan referenced in Section 4. Fidelity Brokerage Services LLC will accept the proceeds from the 529 plan you administer and place the proceeds in a brokerage account that will hold units of interest in a Fidelity-managed 529 plan. Please provide documentation so that principal and earnings amounts are appropriately recorded. Successor Custodian/Trustee Signature Did you sign the form? Send the ENTIRE form and any required documents to Fidelity Investments. Questions? Go to Fidelity.com/college or call 800-544-1914. Make checks payable to: Fidelity Brokerage Services LLC Use postage-paid envelope, drop off at a Fidelity Investor Center, OR deliver to: Regular mail Overnight mail Fidelity Investments Fidelity Investments Attn: CPSC Attn: CPSC PO Box 770001 100 Crosby Parkway KC1K Cincinnati, OH 45277-0015 Covington, KY 41015 On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 460167.7.0 (12/18) 1.715310.115 Page 4 of 4 007980404
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