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Get Fidelity Non-Prototype Retirement Account Withdrawal 2011

Account. • For a brokerage account, complete Sections 1, 2A, 3, and 4 (skip Section 2B) • For a mutual fund account, complete Sections 1, 2B, 3, and 4 (skip Section 2A) If you have any questions, call us anytime at 1-800-544-5373 or visit us at Fidelity.com. Return completed form to: Fidelity Investments, Attn: Distributions, P.O. Box 770001, Cincinnati, OH 45277-0035. 1 PLAN AND TRUST INFORMATION Name of Trustee Name of Employer Plan Name of Plan Participant (if applicable) Evening Phon.

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