/BOSTON/xinet/BosWork/Jobs/30242/PIECE13/25543 04 FRM 529Rollove 529 College Savings Plan Rollover Instructions

User Manual:

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Page Count: 4

1.715310.115 007980401
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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
• According 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.
• Submit this form directly to Fidelity, not to the 529 plan
administrator from which you are requesting the funds
to be transferred.
• 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.
• You are responsible for providing Fidelity with the
principal and earnings breakdown of the amount of this
rollover. See Section 3 for documentation requirements.
• Your 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.
• Do 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.
• Important: You must have an existing Fidelity-
managed 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 Social Security or Taxpayer ID Number
Daytime Phone
Beneficiary Student Information
Name Social Security or Taxpayer ID Number
Date of Birth MM DD YYYY
This phone number may
be used if we have
questions, but will not
be used to update your
account information.
Form continues on next page.
Print
Reset
Save
2. Rollover between Fidelity-managed 529 Plans Complete only if both
accounts are held with Fidelity.
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
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Total Dollar Amount $.
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.
Rollover 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.
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.
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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
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
Transferring Firm Name
Contact Person
Daytime Phone Extension
Transferring Firm Address
City State ZIP Code
Transfer Instructions
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:
Portfolio Dollar Amount
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Portfolio Dollar Amount
OR
ALL
$.
Total Dollar Amount $.
Check the type of
529 account you are
requesting to transfer
to Fidelity.
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.
Check only one.
Attach extra sheets
for additional
portfolio listings.
Form continues on next page.
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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)
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
Fidelity Investments
Attn: CPSC
PO Box 770001
Cincinnati, OH 45277-0015
Overnight mail
Fidelity Investments
Attn: CPSC
100 Crosby Parkway KC1K
Covington, KY 41015
5. Signature All owners of both accounts must sign this form
By signing below, you:
• Certify that you have read the Fact Kit and
Participation Agreement.
• Understand 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.
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
X
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
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

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