How to Fill Out and Submit the Fidelity Transfer/Rollover/Exchange Form

The Fidelity Transfer/Rollover/Exchange Form is the paper document you use to move retirement money into a Fidelity workplace plan — a 401(k), 401(a), 403(b), or 457(b) — from an outside provider, or to consolidate multiple Fidelity workplace accounts into one.¹ To complete it, you fill in seven short sections identifying yourself, the delivering provider, the account you’re moving, your Fidelity plan, and how you want the incoming money invested, then sign it and mail it to Fidelity with a copy of your most recent statement from the old provider.

One boundary to settle first. If you’re moving a regular brokerage account, an IRA, or an HSA from another firm into Fidelity, this form is not the right tool. Those transfers run through Fidelity’s online Transfer of Assets process at Fidelity.com/toa, where you enter the delivering firm, upload a statement, and track the request from a dashboard.² The paper form is specifically for employer-sponsored retirement accounts at Fidelity.

What to Gather Before You Start

Fill in every field in one sitting. Stopping midway invites mistakes, and mistakes on this form mean weeks of delay. Pull these together before you pick up a pen:

Your most recent statement from the delivering provider. The instructions require you to include a copy with the form, and it is also your reference for the provider’s exact legal name, mailing address, and your account or contract number.¹
Your Social Security number or taxpayer identification number.
Your Fidelity plan details: the name and city/state of the employer sponsoring the account, the plan type, and the plan number.
The dollar amount or percentage you want to move. For an everything-at-once transfer, you’ll pick Full Liquidation/100%; otherwise you’ll specify a dollar amount or a percentage.
Your investment election preferences. You can accept the elections already on file with Fidelity, or direct the incoming money to specific funds by name, fund code, and percentage.

If you can’t find your account number on the old statement, call the previous provider for it. Submitting without one forces Fidelity to look up the account by Social Security number, which slows the process.¹

One more preliminary check. You must already have a Fidelity retirement account under the receiving employer’s plan. If you don’t, enroll first; the form won’t create the account for you.¹

Filling Out the Form Section by Section

The form has seven sections. Most are mechanical. A couple have details that trip people up.

Section 1: Your Information

Enter your Social Security number or taxpayer ID, date of birth, full legal name, mailing address, phone numbers, and email. Use your name exactly as it appears on your Fidelity account. A mismatch here is one of the most common reasons transfers get flagged for manual review.

Section 2: Investment Provider You Are Moving Money From

Copy the delivering provider’s legal name and mailing address directly from your most recent statement. If what you write doesn’t match the firm’s own records, the request can bounce. Include the provider’s phone number so Fidelity can reach them with questions during processing.¹

Section 3: Account(s) or Contract(s) to Move

Enter the account or contract number from the delivering provider, the type of account (Traditional IRA, Roth IRA, 401(k), 403(b), and so on), and the liquidation amount. Full Liquidation/100% tells Fidelity to request your entire balance. If you choose Partial Liquidation, write in a specific dollar amount or percentage. Leave this blank and Fidelity defaults to requesting 100%.¹

The account type you select determines whether Fidelity processes the transaction as a transfer or a rollover. Moving between matching plan types, like 401(k) to 401(k), is a transfer. Moving between different types, like IRA to 401(k) or 403(b) to 401(k), is a rollover, which has different tax reporting consequences.³

Section 4: Your Fidelity Account Information

Identify the employer sponsoring your Fidelity retirement account, the employer’s city and state, whether you’re still employed there, the plan type, and the plan number.¹

Section 5: Investment Instructions

Two choices. Select Yes to invest the incoming money according to whatever elections are already on file with Fidelity. Or list specific fund names, fund codes, and the percentage for each. The percentages must add up to exactly 100%. If your instructions are incomplete, don’t total 100%, or reference invalid fund codes, Fidelity invests the money in the plan’s default investment option instead.¹

Section 6: Employer Plan Acceptance

Some plans require an authorized signature from your employer before Fidelity can accept the incoming assets. Check with your HR department or call Fidelity at 1-800-343-0860 to find out whether your plan requires this step. If it does, have your plan administrator sign and date this section before you submit the form.¹

Section 7: Signature and Date

Sign and date the form. Fidelity will not process it without both. The language above the signature line certifies that your information is accurate and authorizes Fidelity to initiate the transfer or rollover.

Direct Rollover Versus Indirect Rollover

This is where people lose money, and it is entirely avoidable. The way you complete the form steers the transaction into direct-rollover territory, and that’s where you want it.

A direct rollover sends the money from the old plan straight to Fidelity without passing through you. The check is made payable to the receiving plan or custodian, no taxes are withheld, and the full balance arrives. This is the standard path when Fidelity initiates the request on your behalf through this form.⁴

An indirect rollover puts the money in your hands first. The old plan cuts a check to you, and federal law requires the plan to withhold 20% for income taxes before sending it.⁵ You then have 60 days to deposit the full original amount into the new account, including replacing the 20% that was withheld out of your own pocket. Roll over only the 80% you received, and the missing 20% is treated as a taxable distribution and may also trigger the 10% early withdrawal penalty if you’re under 59½.⁶

If you’ve already received a distribution check made payable to you, you’re in indirect-rollover territory and the 60-day clock is running. If you haven’t yet, use this form so Fidelity initiates a direct request to the delivering provider.

The One-Rollover-Per-Year Limit

If you’re moving money from an IRA, know that the IRS allows only one IRA-to-IRA rollover (where the money passes through your hands) in any 12-month period, and it aggregates all your IRAs — Traditional, Roth, SEP, SIMPLE — as a single IRA for this count.⁷ Violate the rule and the distribution is included in gross income, you may owe the 10% penalty, and if the money lands in another IRA it’s treated as an excess contribution subject to a 6% penalty for every year it stays there.⁴

Trustee-to-trustee transfers, where the money moves directly between custodians without a check to you, are not counted as rollovers and have no annual limit. IRA-to-plan and plan-to-IRA rollovers are also exempt.⁴ Using this form keeps the transaction in trustee-to-trustee territory and sidesteps the limit.

When You Need a Medallion Signature Guarantee

A Medallion Signature Guarantee is a specialized stamp confirming that your signature is genuine and that you have authority for the transaction. It is not a notarization. The guarantor institution accepts financial liability if the signature turns out to be forged, and each stamp carries a surety limit — the maximum dollar amount the institution will cover — that typically ranges from $100,000 to $10,000,000 depending on the institution’s participation level.⁸⁹

Fidelity requires a Medallion stamp on certain transfer scenarios, particularly those involving changes to account registration or standing transfer instructions. If you complete the paperwork at a Fidelity Investor Center in person, the guarantee is waived.¹⁰ Otherwise, visit a bank, credit union, or brokerage where you have an existing relationship, bringing valid photo ID and the unsigned form. The official must witness you signing before applying the stamp.

Three programs issue these guarantees: the Securities Transfer Agents Medallion Program (STAMP), the Stock Exchanges Medallion Program (SEMP), and the New York Stock Exchange Medallion Signature Program (MSP). Fidelity accepts any of the three. Call ahead, because many bank branches no longer offer the service.

Where to Send the Completed Form

Once the form is signed, dated, and stamped if required, and you have a copy of your most recent statement attached, mail it to one of two addresses depending on the carrier.

Regular USPS mail: Fidelity Investments, ATTN: TOA, PO Box 770001, Cincinnati, OH 45277-0036.¹¹
Express or overnight mail: Fidelity Investments, 100 Crosby Parkway KC2Q, Covington, KY 41015.¹¹

FedEx and UPS cannot deliver to P.O. boxes, so use the Covington street address for anything that isn’t going through USPS. Use tracking. You are mailing a signed document authorizing the movement of retirement savings, and knowing it arrived matters.

Why Forms Get Rejected

Most transfer problems are paperwork problems, and nearly all paperwork problems are preventable. Run through this before you seal the envelope:

Name mismatch between the form and the delivering account. If you changed your name after opening the old account and didn’t update it there, resolve that with the delivering firm first.
Wrong or missing account number at the delivering firm. This is the fastest route to rejection.
No statement attached. The instructions require a copy of your most recent statement from the delivering provider.
Missing signature or date. Fidelity explicitly cannot process the form without both.¹
Employer signature needed in Section 6 but not obtained. Confirm with HR or Fidelity before submitting.
Open orders or restrictions at the delivering firm. Margin balances, outstanding 401(k) loans, pending trades, or legal holds can block the transfer until resolved. Cancel any open orders before you submit.
Medallion stamp missing, expired, or illegible when one is required.
Investment instructions in Section 5 that don’t total 100% or reference invalid fund codes. The money will route to the plan’s default option instead of where you intended.

Rollovers from employer plans typically take longer than brokerage transfers because the old plan administrator must verify your distribution eligibility, run its own internal review, and then issue payment. Two to four weeks is a reasonable expectation, and some administrators only process distributions on a monthly or quarterly schedule. Clean paperwork is the one variable you control.

1
Fidelity. Transfer/Rollover/Exchange Form Instructions
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Fidelity. Transfer Your Assets-Investments to Fidelity
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Fidelity. Fidelity Transfer/Rollover/Exchange Form
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Internal Revenue Service. Rollovers of Retirement Plan and IRA Distributions
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Office of the Law Revision Counsel. 26 USC 3405 – Special Rules for Pensions, Annuities, and Certain Other Deferred Income
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eCFR. 26 CFR 1.402(c)-2 – Eligible Rollover Distributions
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Office of the Law Revision Counsel. 26 USC 408 – Individual Retirement Accounts
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Securities Transfer Association. STAMP
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Investment Company Institute. Medallion Signature Guarantee Considerations and Alternatives
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Fidelity. Standing Transfer Instructions
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Fidelity. Fidelity Mailing Addresses