Get Fidelity Insurance Network Web Access Request Form

Filling out the Fidelity Insurance Network Web Access Request Form online is a straightforward process that enables you to authorize an individual to have view-only access to your Fidelity contracts. This guide will provide step-by-step instructions to ensure that you complete the form accurately and effectively.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, 'Contract Owners', provide the name of the contract owner or trust and the name of the joint owner or authorized person. This information identifies the primary holders of the contracts.
3. In the next section, 'Fidelity Contract(s) Included', list the annuity contract numbers along with the names of the Fidelity Insurance Network contract issuers. Include all relevant contracts for which you wish to grant access.
4. Proceed to the 'Interested Party Information' section. Enter the name and Social Security or Taxpayer ID Number of the interested party. Provide their address, city, state, ZIP code, date of birth, and phone number. Here, it is essential to accurately input information as it directly relates to access permissions.
5. Next, indicate the relationship of the interested party, selecting from the options provided such as power of attorney (POA). This clarifies the authority of the individual receiving access.
6. In the 'Signatures and Dates' section, all contract owners must sign the form. Ensure that you print your name and date, alongside the signature. It is important to acknowledge your responsibility in maintaining records of any interested parties you authorize.
7. After completing all sections, review the form for accuracy. Save changes, then download, print, or share the form as needed. Ensure the entire form is sent to Fidelity using the specified mailing options.

Complete and submit your Fidelity Insurance Network Web Access Request Form online today for seamless access management.