Account Address(BS) 3. Account Type(s) 4. Account Type 2() 5. Account Type 3 6. Account Type 4 7. Account Type 5 8. Account Type 6 9. Account Type 7 10. Account Type 8 11. Account Type 9 12. Account Type 10 13. Account Type 11 14. Account Type 12 15. Account Type 13 16. Account Type 14 17. Account Type 15 18. AGE 19. BORN 20. DOB 21. EDUCATION 22. EMPLOYER (ORGANIZATION) 23. INTEREST (ORGANIZATION) 24. INTEREST (COUNTRY) 25. INTEREST (STATE) 26. INSTITUTION (ORGANIZATION) 27. INTEREST (UNITED STATES) 28. INCOME (ORGANIZATION) 29. INCOME (COUNTRY) 30. INCOME (STATE) 31. LABOR (ORGANIZATION) 32. LABOR (COUNTRY) 33. LABOR (STATE) 34. MAINTENANCE (ORGANIZATION) 35. MAINTENANCE (COUNTRY) 36. MAINTENANCE (STATE) 37. MAINTENANCE (UNITED STATES) 38. LOCAL AREA.
If your account is designated as part of a defined contribution plan, enter the appropriate information in paragraph (e) of this section instead.
Note: If you received a distribution of excess Fidelity Fund money (i.e., more than 5% of your combined investment and Roth IRA deposits), you may be eligible to add the unused funds to your retirement account. To view or make a request, you can visit the “Additional Information” tab in Accounts to the left of the page where you view the distribution.
If your account has not yet been credited with excess funds, you must add the appropriate amounts to your account in order to receive the excess amount.
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Print Save Reset Questions? Go to Fidelity.com or call 1-800-544-6666. Financial Advisor Fee Request IRA Use this form to authorize Fidelity to distribute funds to your designated financial advisor
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