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Get Fidelity Distribution Request Form 2012-2024

Ian/Trustee Choose one. This Account is: an IRA a 403(b) plan an employer-sponsored, qualified 401(a) plan an eligible 457(b) plan maintained by a state governmental agency Please indicate below if any designated Roth amounts in your account should be rolled over to another custodian/trustee, as applicable. Include Roth 403(b) assets Please provide us with the name of the receiving custodian/trustee. Name of Custodian/Trustee A check will be made payable to the.

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