Page 1 of 7
Questions? Go to Fidelity.com or call 800-343-3548.
One-Time Withdrawal — Defined Contribution
Retirement Plan
Use this form to request a one-time withdrawal from a Fidelity Self-Employed 401(k), Profit Sharing, or Money Purchase Plan
account. Possible requests include a one-time, immediate distribution; a qualified or direct conversion to a Roth IRA; or a direct
rollover. Do NOT use this form for a Traditional, Rollover, Roth, SEP, SIMPLE, or Inherited IRA; Investment-Only Retirement Plan or
nonretirement accounts; or annuities. Type on screen or fill in using CAPITAL letters and black ink. If you need more room for information,
make a copy of the relevant page.
Helpful to Know
• Distributions from the Defined Contribution Retirement
Plan [i.e., Profit Sharing, Money Purchase Pension Plan,
or Self-Employed 401(k) Plan] are only permitted when
a participant reaches a triggering event as defined in
Section 2. Distributions for any other reason may result
in plan disqualification.
• Distributions to married participants from any money
purchase plan and certain profit sharing plans must be
made in the form of a joint and survivor annuity, unless
your spouse waives this right by providing spousal
consent on this form. You are encouraged to consult
your tax advisor regarding the tax implications
associated with each distribution.
• You should also confirm that Fidelity has your most current
address prior to submission so that we can withhold
appropriate taxes. See the General Instructions and the
Marginal Rate Tables contained in the IRS Form W-4R at
Fidelity.com/W-4R for additional information. To update
your address, go to Fidelity.com.
• Nonresident aliens must provide IRS Form W-8BEN
and a U.S. or foreign tax identification number.
• If you are making withdrawals from both a money
purchase plan and a profit sharing plan, you must
complete a separate form for each account.
• If this form directs Fidelity to sell shares of any security, be
aware that the timing of the transaction depends on when
we receive this form, which is outside of your control. To
better control the timing of the transaction, you should
direct the sale of securities online or through a Fidelity
representative. Note: Certain securities (such as options,
certain fixed income securities, and thinly traded securities)
may not be eligible to sell via this form, which may result
in Fidelity not being able to process this withdrawal
asrequested.
• Any fees charged or expenses incurred in connection
with your instructions will be assessed at the “rep-assisted”
rates. Fees and expenses may be lower if you instead
place your trades online. Please refer to the Schedule of
Fees for more information.
• For mutual funds, note that:
– Withdrawals could trigger redemption or transaction
fees (see the applicable fund prospectus).
– If a fund is closed to new investors, you will not be
able to purchase new shares of the fund in the future
if you draw your fund balance down to zero.
1. Account Owner
Name Fidelity Account Number
Social Security or Taxpayer ID Number Date of Birth MM DD YYYY
Primary Phone
Plan Information
Plan Name
Money Purchase Spousal consent and notary required.
Profit Sharing [including Self-Employed 401(k)]
This phone number
may be used if we have
questions, but will not
be used to update your
account information.
1.812111.120 015221101
Form continues on next page.
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Page 2 of 71.812111.120 015221102
2. Request Reason
Normal You are AT LEAST 59½ at the time of distribution.
Disability You are younger than 59½ at the time of distribution. You must qualify under the Plan definition of “disability” as
defined in Article 2.16 of the Defined Contribution Retirement Plan. If you are chronically ill or disabled, you must furnish a physi-
cian’s certification to the Plan Administrator in order to be eligible for exemption from the 10% early withdrawal penalty.
Qualified birth or adoption Distribution up to $5,000 per child made within the one-year period following the date of birth
or the legal adoption is finalized for certain qualified birth or adoption expenses. Distribution may be repaid within three years.
The amount is eligible to be repaid as a rollover contribution.
Qualified disaster recovery distribution Distribution(s) up to an aggregate of $22,000 made on or after the date of the
incident and within the first 180 days after the date of the incident. Distributions are taxed ratable over three years and can be
repaid over the three-year period starting from the date of the distribution.
Domestic abuse (Not available for Money Purchase Plans) Distribution up to $10,000 or 50% of account balance within the
one-year period following the incident by a spouse or domestic partner. Distributions can be repaid over a three-year period
starting from the date of the distribution.
Military service If active duty with an armed service for more than 30 days, you have the option to request a distribution of your
employee deferrals.
Qualified reservist distribution If you are an active duty member of the Reserves or National Guard, you can take elective
deferrals beginning on the date of the order or call to active duty after 179 days of active service. This distribution is exempt from
the 10% early withdrawal penalty.
Separated from service
Death of plan participant
Plan termination
Required Minimum Distribution (RMD)
Check here if you are required to take an RMD and are requesting to do so with this form. Please note that IRS rules pro-
hibit your RMD from being rolled over/converted; by checking this box, you are directing Fidelity to distribute your RMD
as a separate payment from the rollover/conversion. You will be able to choose the method of payment(s) in Section 4.
Amount
$
3. Distribution Instructions
If this form directs Fidelity to sell shares of any securities (including mutual funds), be aware that:
• The timing of the transaction (i.e., when
your trade is processed) depends on
when we receive this form, which is
outside of your control. Trades may take
up to five business days to process once
determined to be in good order.
• If you want to better control the timing
of the transaction, you should direct the
sale of securities online or through a
Fidelity representative.
• If you withdraw all assets from your
source account, that account will
beclosed.
• Once we receive this form in good
order, you cannot cancel your
distributionrequest.
In the event that transactions cannot be processed within five business days of determining your request to be in good order,
Fidelity will notify you and you may have to resubmit your request on the unsold positions within your account.
ALL core cash and Fidelity money market funds in your brokerage account
Skip to Section 4.
ONLY the following amount of cash in your brokerage account.
Skip to Section 4.
Dollar Amount
If the amount you indicate is greater
than your core account balance,
your request will be denied.
$
ENTIRE VALUE of your account in cash (all eligible securities will be sold)
Check ONLY one.
Provide the RMD
amount to be dis-
tributed. If the box
is checked and no
amount is provided,
Fidelity will calculate
your RMD amount.
Check ONLY
one and provide
any additional
requested
information.
Distribution Instructions continues on next page.
1.812111.120 Page 3 of 7 015221103
ENTIRE VALUE of your account as shares (in kind)
You must choose to distribute into a Fidelity account in
Section 4.
ONLY the following eligible securities and amounts:
Sell and distribute as cash
Distribute as shares (in kind)
Security Name or Symbol
ALL
shares
ONLY this
many shares:
Number of Shares
ONLY this
dollar amount:
Fidelity Mutual Fund
accounts only
.
Dollar Amount
$
Sell and distribute as cash
Distribute as shares (in kind)
Security Name or Symbol
ALL
shares
ONLY this
many shares:
Number of Shares
ONLY this
dollar amount:
Fidelity Mutual Fund
accounts only.
Dollar Amount
$
4. Distribution Method
You must obtain a Medallion signature guarantee in Section 6b if requesting a bank wire, if sending a distribution to a payee other than
the account owner or to an alternate address, if the address on the account has been changed within the past 10 days, or for any
transaction over $100,000.
4a. Distribute into your Fidelity nonretirement account
Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol Fidelity Mutual Fund accounts ONLY e.g., 2AB-123456
4b. Direct rollover/conversion of an eligible distribution into an account held with Fidelity. Please note that while
rollovers are generally non-taxable transactions, conversions to a Roth IRA are generally taxable as income in
the year of the conversion. This distribution method is not available for qualified birth or adoption distributions.
Fidelity Account Number Fidelity Fund Name or Symbol Fidelity Mutual Fund accounts ONLY e.g., 2AB-123456
Direct rollover to a Fidelity Traditional IRA or Fidelity Rollover IRA
Direct conversion to a Fidelity Roth IRA
Direct rollover to a Fidelity Inherited IRA Decedent must be the same on both accounts.
4c. Direct rollover/conversion of an eligible distribution into an established non-Fidelity account. Please note that
while rollovers are generally non-taxable transactions, conversions to a Roth IRA are generally taxable as income
in the year of the conversion. This distribution method is not available for qualified birth or adoption distributions.
Direct rollover to a non-Fidelity Traditional IRA or Rollover IRA
Direct conversion to a non-Fidelity Roth IRA
Direct rollover to a non-Fidelity Inherited IRA The decedent must be the same.
Trustee/Custodian Name Account Number
For Benefit Of/Attention Address
City State/Province ZIP/Postal Code Country
4d. Bank wire to a bank or credit union account or someone else’s (cash only): Ask the bank for its wire routing
number. The bank may charge a fee for wire transfers.
Check the appropriate
method(s) and provide
all required informa-
tion. If you indicated
in Section 2 that you
are requesting your
RMD, choose method
4a, 4d, 4e, or 4f. If you
would also like to roll
over/convert any of
the remaining balance,
choose from method
4b or 4c.
Distribution Method continues on next page.
3. Distribution Instructions, continued
1.812111.120 Page 4 of 7 015221104
Wire Recipient
Bank Routing /ABA Number Bank Name
Account Number Account Owner Name(s) Required
Address of Wire Recipient
City State/Province ZIP/Postal Code Country
For Further Credit
Additional Details (if applicable)
Instructions to be included with the wire transfer.
Correspondent (Intermediary)
Correspondent Bank Routing/ABA Number Correspondent Bank Name
Account is OUTSIDE the United States:
SWIFT Code Name of Country
4e. Check mailed to the address of record
Default if no choice indicated or if we are unable to process your choice.
4f. Check mailed to you at an address other than your record address
Address
City State ZIP Code
All bank wire requests
MUST have a Medallion
signature guarantee. A
notary seal/stamp is
NOT a Medallion
signature guarantee.
FULL address is
required for
international wires.
If the bank uses a corre-
spondent bank, provide
the information here.
Correspondent bank
information may not be
required for all wires.
Indicate if the recipient
bank is outside the
United States.
4. Distribution Method, continued
Form continues on next page.
5. Tax Withholding
NOTE: If your distribution is eligible for a rollover/conversion and that is the only payment method chosen in Section 4, tax withholding
is not mandated by the IRS and cannot be withheld on this request. Please skip to Section 6.
Do NOT complete this section if you are not a U.S. person (including a nonresident alien). Instead, the nonresident tax rate of 30% will apply. If
you believe you are entitled to a reduced tax treaty benefit based on your country of residence, provide the IRS Form W-8BEN with the Special
Rates and Conditions section completed to indicate this distribution is eligible for a reduced tax rate with this form. Please note this could delay
the funds leaving your account by up to 3 business days. If your tax treaty claim is invalid, the distribution will be processed with 30% withholding.
Mandatory 20% Withholding
Per IRS rules, you cannot elect out of the 20% federal tax withholding if your distribution is eligible to be rolled over/converted and you
have elected a different payment method. This mandatory withholding of 20% does not apply if you are taking your RMD.
Distributions not subject to the Mandatory 20% Withholding
For one-time withdrawals (i.e., qualified birth or adoption distributions) that are not subject to the 20% withholding as described above,
such as RMDS, the default withholding rate is 10%. You can choose to have a different rate by entering a rate between 0% and 100% below.
Generally, you can’t choose less than 10% for payments to be delivered outside the United States and its possessions. If federal income tax
withholding is applied to your distribution, state income tax may also apply. See Federal and State Tax Withholding — Retirement Plan
Withdrawals at the end of this form.
Complete if you would like a rate of withholding that is different from this default withholding rate and your distribution is not sub-
ject to the mandatory withholding. You should review the General Instructions and the Marginal Rate Tables contained in the IRS Form
W-4R at Fidelity.com/W-4R for additional information, which you can download for free. If you don’t have access to a computer, you may
request a copy by calling Fidelity, or the IRS at 800-829-1040.
Federal
Do NOT withhold federal taxes.
Withhold federal taxes at the rate of:
Percentage
Whole numbers; no dollar amounts or
decimals. Note that if there is federal tax
withholding, certain states require that
there also be state tax withholding.
%
State
Do NOT withhold state taxes unless required by law.
Withhold state taxes at the applicable rate.
Withhold state taxes at the rate of:
Percentage
Whole numbers; no dollar amounts
or decimals.
%
6. Signatures and Dates Plan Administrator and Plan Participant must sign and date.
Who must sign?
The Plan Administrator must sign in 6a.
The Plan Participant must sign in 6b.
If the distribution is due to death from your inherited retirement plan account:
– The executor of the Plan Administrator’s estate must sign in 6a.
– The inherited account owner must sign in 6b.
– No spousal beneficiary signature is required. Note: Spousal consent to the designation of a nonspouse beneficiary is required.
If you are married, your spouse must consent to this distribution by signing in the presence of a notary public in 6c. if:
– You are a participant in a profit sharing plan and elect to have your distribution paid in the form of a life annuity contract;
– You are a participant in a money purchase pension plan and elect a form of distribution other than a joint and survivor annuity, or you
are a participant in a profit sharing plan consisting of assets that have been transferred from a plan previously subject to the spousal
consent rules, such as a money purchase pension plan, and elect a form of distribution other than a joint and survivor annuity.
Spousal consent is not required for an RMD.
Important note: A participant may waive a qualified joint and survivor annuity option, and a spouse may consent to such waiver, provided it
is made within 90 days before the first plan distribution.
Indicate the plan participant’s marital status:
Single Married
By signing below, you:
• Certify that this designation is being made
pursuant to the Defined Contribution
Retirement Plan, Trust Agreement, and the
instructions contained herein.
• Authorize and request the trustee of the
Defined Contribution Retirement Plan and
the separate Trust Agreement, Fidelity
Management Trust Company, or its agents,
affiliates, employees, or successors, to make
the above withdrawal.
• Agree that the participant, if over the appli-
cable RMD age, accepts full responsibility for
withdrawing the RMD required by section
401(a)(9) of the Internal Revenue Code.
• Indemnify the trustee of the Defined
Contribution Retirement Plan and the
separate Trust Agreement, its agents,
affiliates, employees, and successors from
any liability associated with the distributions
made at the direction of you and/or the Plan
Administrator.
• Authorize and request National Financial
Services LLC (NFS) and/or Fidelity Brokerage
Services LLC (FBS) to make distributions
according to the above instructions. If you
have indicated herein that such payments
are to be credited to your bank account, you
authorize the bank or credit union maintain-
ing the account indicated above to accept
any such credit entries initiated by NFS or
FBS to such account and to credit the same
Check one in each
column. IRA owner’s
legal/residential
address determines
which state’s tax
rules apply.
1.812111.120 Page 5 of 7 015221105
Signatures and Dates continues on next page.
1.812111.120 Page 6 of 7 015221106
to such account, without responsibility for the
correctness thereof or for the existence of any
further authorization relating hereto.
• Certify that the trust is a qualifying nonspouse
beneficiary, for the purpose of section
402(c) of the Internal Revenue Code, and is
therefore eligible to directly roll over assets
to an inherited IRA, to the extent that assets
inherited by a trust are being directly rolled
over to an inherited IRA, as trustee for the
above-referenced trust.
• Understand that it is your responsibility to
ensure that only eligible assets are rolled over
and all minimum distribution requirements
are satisfied, to the extent that plan assets are
being directly rolled over to an IRA or inher-
ited IRA or directly converted to a Roth IRA.
•
Confirm, if you are not a U.S. person, you
have attached, or have on file with Fidelity,
IRS Form W-8BEN that includes your U.S. or
foreign tax identification number.
• Have viewed, read, and understand the IRS
Instructions for Form W-4R.
• Certify that the address associated with this
account is current and up to date.
• Acknowledge that for distributions due to
a Qualified Disaster Recovery Distribution,
Qualified Birth or Adoption Distribution,
Domestic Abuse, Military Service, or Qualified
Reservist Distribution, you have met all the
requirements to take a withdrawal from the
Plan and that this withdrawal is exempt from
the 10% penalty.
Customers Requesting Trade Processing:
• Authorize Fidelity to process trades on
yourbehalf.
• Acknowledge that you are delegating to
Fidelity the discretion to determine the price
and time at which certain securities should be
sold pursuant to your instructions contained in
this form.
• Acknowledge that trades may take up to five
business days to process once the request is
received and determined to be in good order,
and that your authorization shall remain in
effect during the entire period.
• Acknowledge that certain securities cannot be
sold through this form and may require you to
call a representative or go online to process
the trades.
For Connecticut Residents:
• Acknowledge that, as a resident of CT, your
distributions from retirement accounts are
subject to the highest marginal tax rate. If
you are exempt from state tax, you have
the option to elect out of state tax with-
holding. Otherwise, penalties may apply.
The penalty for reporting false information
is a fine of not more than $5,000, imprison-
ment for not more than five years, or both.
• Confirm that your state tax withholding
election is true, complete, and correct.
For Plan Administrators:
• Acknowledge that for distributions due to
a Qualified Disaster Recovery Distribution,
Qualified Birth or Adoption Distribution,
Domestic Abuse, Military Service, or
Qualified Reservist Distribution, the plan
participant has met all the requirements
to take a withdrawal from the Plan and
that this withdrawal is exempt from the
10% penalty.
• Acknowledge that you have confirmed
eligibility for the withdrawal based on the
plan rules. You also acknowledge that you
are responsible for keeping copies of the
documentation necessary to evidence the
distribution is exempt from the 10% penalty.
6a. Plan Administrator or Executor of the Plan Administrator’s Estate
PRINT PLAN ADMINISTRATOR/EXECUTOR NAME
PLAN ADMINISTRATOR/EXECUTOR SIGNATURE DATE MM/DD/YYYY
SIGN
X X
6b. Plan Participant or Inherited Account Owner
A Medallion signature guarantee is required if requesting a bank wire, if sending a withdrawal to an alternate payee or address, if the address
on the account has been changed within the past 10 days, or for any transaction over $100,000. You can get a Medallion signature guarantee
from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a Medallion signature guarantee.
PRINT PLAN PARTICIPANT/INHERITED ACCOUNT OWNER NAME
MEDALLION SIGNATURE GUARANTEE
PLAN PARTICIPANT/INHERITED ACCOUNT OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
6. Signatures and Dates, continued
Signatures and Dates continues on next page.
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 454857.18.0 (01/24)
Did you sign the form? Send the ENTIRE form to
Fidelity Investments.
Questions? Go to Fidelity.com or call 800-343-3548.
Regular mail
Attn: Retirement Distributions
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0035
Overnight mail
Attn: Retirement Distributions
Fidelity Investments
100 Crosby Parkway KC1B
Covington, KY 41015
6. Signatures and Dates, continued
1.812111.120 Page 7 of 7 015221107
6c. Spousal Consent for Plan Participant Distributions Sign this section in the presence of a notary public.
By signing below, you:
• Consent to the form of distribution selected
by your spouse herein.
• Understand that by signing this consent, you
are giving up the right to receive annuity
benefit payments that would otherwise be
payable to you.
PRINT SPOUSE NAME
SPOUSE SIGNATURE DATE MM/DD/YYYY
SIGN
X X
Important Note: CA Notaries are permitted to submit a separate page notary document. If used, it must identify the
document being notarized.
Notice to CA Residents: A Notary Public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of
that document.
Certificate of Acknowledgement of Notary Public
Must be a U.S. Notary. Foreign notary or consular seals may NOT be substituted.
State of , in the County of , subscribed and sworn to before me by the
above-named individual who is personally known to me or who has produced as identification, that the
foregoing statements were true and accurate and made of his/her own free act and deed, on / / .
PRINT NOTARY NAME
NOTARY SEAL / STAMP
NOTARY SIGNATURE DATE MM/DD/YYYY
SIGN
X X
My commission expires / / .
Helpful to Know
• Federal and state tax withholding rules can change, and
the information cited below may not reflect the current
withholding from a federal or state perspective. Consult
your tax advisor, the IRS, and/or your state taxing
authority to obtain the most up-to-date information
pertaining to your situation.
• The IRS requires Fidelity to provide you with the
Marginal Rate Tables and the Tax Withholding
Instructions from the IRS Form W-4R.
• Each state sets its own withholding rates and require-
ments on taxable distributions. We apply these rates
unless you direct us not to (where permitted) or you
request a higher rate.
• Your account’s legal/residential address determines
which state’s tax rules apply. You should confirm that
the address on your account is current prior to submit-
ting your request.
• You are responsible for paying your federal, state, and
local income taxes and any penalties, including penal-
ties for insufficient withholding.
• The federal and/or state tax withholding rate, if
indicated, must be provided as a whole number from
1% to 100% for any one-time withdrawals, or from 1%
to 99% for any automatic withdrawals.
Federal Tax Withholding Information
2024 Marginal Rate Tables
You may use these tables to help you select the appropriate withholding rate for this payment or distribution. Add your
income from all sources and use the column that matches your filing status to find the corresponding rate of withholding.
See the General Instructions section for more information on how to use this table. (Note: This is an excerpt from the IRS
Form W-4R. For the complete copy, please go to Fidelity.com/W-4R or IRS.gov/pub/irs-pdf/fw4r.pdf.)
Single
or
Married filing separately
Married filing jointly
or
Qualifying surviving spouse
Head of household
Total income
over—
Tax rate for every
dollar more
Total income
over—
Tax rate for every
dollar more
Total income
over—
Tax rate for every
dollar more
$0
14,600
26,200
61,750
115,125
206,550
258,325
623,950*
0%
10%
12%
22%
24%
32%
35%
37%
$0
29,200
52,400
123,500
230,250
413,100
516,650
760,400
0%
10%
12%
22%
24%
32%
35%
37%
$0
21,900
38,450
85,000
122,400
213,850
265,600
631,250
0%
10%
12%
22%
24%
32%
35%
37%
*If married filing separately, use $380,200 instead for this 37% rate.
Page 1 of 3
1.9585653.107
General Instructions on Federal Tax
Withholding
Nonperiodic payments—10% withholding. Your payer
must withhold at a default 10% rate from the taxable amount
of nonperiodic payments unless you enter a different rate.
Distributions from an IRA that are payable on demand are
treated as nonperiodic payments. Note that the default rate
of withholding may not be appropriate for your tax situation.
You may choose to have no federal income tax withheld.
See the specific instructions below for more information.
Generally, you are not permitted to elect to have federal
income tax withheld at a rate of less than 10% (including
“-0-”) on any payments to be delivered outside the United
States and its territories.
Note: If you don’t give Form W-4R to your payer, you don’t
provide an SSN, or the IRS notifies the payer that you gave
an incorrect SSN, then the payer must withhold 10% of the
payment for federal income tax and can’t honor requests to
have a lower (or no) amount withheld. Generally, for payments
that began before 2024, your current withholding election (or
your default rate) remains in effect unless you submit a new
withholding election.
Eligible rollover distributions—20% withholding.
Distributions you receive from qualified retirement plans (for
example, 401(k) plans and section 457(b) plans maintained by
a governmental employer) or tax-sheltered annuities that are
eligible to be rolled over to an IRA or qualified plan are sub-
ject to a 20% default rate of withholding on the taxable
Federal and State Tax Withholding —
Retirement Plan Withdrawals
amount of the distribution. You can’t choose withholding at a
rate of less than 20% (including “-0-”). Note that the default
rate of withholding may be too low for your tax situation. You
may choose to enter a rate higher than 20%.
Note that the following payments are not eligible rollover
distributions: (a) qualifying “hardship” distributions, and
(b) distributions required by federal law, such as required
minimum distributions. See Pub. 505 for details. See also
Nonperiodic payments—10% withholding above.
Payments to nonresident aliens and foreign estates.
Do not use Form W-4R. See Pub. 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities, and Pub. 519, U.S.
Tax Guide for Aliens, for more information.
Tax relief for victims of terrorist attacks. If your disability
payments for injuries incurred as a direct result of a terrorist
attack are not taxable, enter “-0-”. See Pub. 3920, Tax Relief
for Victims of Terrorist Attacks, for more details.
Specific Instructions for IRS Form W-4R
Line 1b
For an estate, enter the estate’s employer identification
number (EIN) in the area reserved for “Social security
number.”
Line 2
More withholding. If you want more than the default rate
withheld from your payment, you may enter a higher rate on
line 2.
Less withholding (nonperiodic payments only). If permit-
ted, you may enter a lower rate on line 2 (including “-0-”) if
you want less than the 10% default rate withheld from your
payment. If you have already paid, or plan to pay, your tax
on this payment through other withholding or estimated tax
payments, you may want to enter “-0-”.
Suggestion for determining withholding. Consider using
the Marginal Rate Tables on page 1 to help you select the
appropriate withholding rate for this payment or distribution.
The tables are most accurate if the appropriate amount of
tax on all other sources of income, deductions, and credits
has been paid through other withholding or estimated tax
payments. If the appropriate amount of tax on those sources
of income has not been paid through other withholding or
estimated tax payments, you can pay that tax through
withholding on this payment by entering a rate that is greater
than the rate in the Marginal Rate Tables.
The marginal tax rate is the rate of tax on each additional
dollar of income you receive above a particular amount of
income. You can use the table for your filing status as a guide
to find a rate of withholding for amounts above the total
income level in the table.
To determine the appropriate rate of withholding from
the table, do the following. Step 1: Find the rate that
corresponds with your total income not including the pay-
ment. Step 2: Add your total income and the taxable amount
of the payment and find the corresponding rate.
If these two rates are the same, enter that rate on line 2.
(See Example 1 below.)
If the two rates differ, multiply (a) the amount in the lower
rate bracket by the rate for that bracket, and (b) the amount
in the higher rate bracket by the rate for that bracket. Add
these two numbers; this is the expected tax for this payment.
To get the rate to have withheld, divide this amount by the
taxable amount of the payment. Round up to the next whole
number and enter that rate on line 2. (See Example 2 below.)
If you prefer a simpler approach (but one that may lead to
overwithholding), find the rate that corresponds to your total
income including the payment and enter that rate on line 2.
Examples. Assume the following facts for Examples 1 and 2.
Your filing status is single. You expect the taxable amount of
your payment to be $20,000. Appropriate amounts have
been withheld for all other sources of income and any
deductions or credits.
Example 1. You expect your total income to be $62,000
without the payment. Step 1: Because your total income
without the payment, $62,000, is greater than $61,750 but
less than $115,125, the corresponding rate is 22%. Step 2:
Because your total income with the payment, $82,000, is
greater than $61,750 but less than $115,125, the correspond-
ing rate is 22%. Because these two rates are the same, enter
“22” on line 2.
Example 2. You expect your total income to be $43,700
without the payment. Step 1: Because your total income
without the payment, $43,700, is greater than $26,200 but
less than $61,750, the corresponding rate is 12%. Step 2:
Because your total income with the payment, $63,700, is
greater than $61,750 but less than $115,125, the correspond-
ing rate is 22%. The two rates differ. $18,050 of the $20,000
payment is in the lower bracket ($61,750 less your total
income of $43,700 without the payment), and $1,950 is in the
higher bracket ($20,000 less the $18,050 that is in the lower
bracket). Multiply $18,050 by 12% to get $2,166. Multiply
$1,950 by 22% to get $429. The sum of these two amounts
is $2,595. This is the estimated tax on your payment. This
amount corresponds to 13% of the $20,000 payment ($2,595
divided by $20,000). Enter “13” on line 2.
Page 2 of 3
1.9585653.107
State Tax Withholding Information
State of residence State tax withholding options
AK, FL, HI, NH, NV, SD,
TN, TX, WA, WY
• No state tax withholding is available (even if your state has income tax).
AR, IA, KS, MA, ME,*
NE, OK, PR,
†
VA, VT
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate or an amount greater as specified by you.
• If you do NOT choose federal withholding, state withholding is voluntary.
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate.
CA, DE, GA,
†
MN,
NC, OR
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate unless you request otherwise.
• If you do NOT choose federal withholding, state withholding is voluntary.
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate.
CT, MI
• CT and MI generally require state income tax of at least your state’s minimum requirements regardless of
whether or not federal income tax is withheld.
• Tax withholding is not required if you meet certain state requirements governing pension and retirement
benefits. Please reference the CT or MI W-4P Form for additional information about calculating the amount
to withhold from your distribution.
• If you are subject to state tax withholding, you must elect state tax withholding of at least your state’s
minimum by completing the Tax Withholding section.
• Contact your tax advisor or investment representative for additional information about your state’s requirements.
DC
Only applicable if taking
a full distribution of entire
account balance.
• If you are taking distribution of your entire account balance and not directly rolling that amount over to
another eligible retirement account, DC requires that a minimum amount be withheld from the taxable
portion of the distribution, whether or not federal income tax is withheld. In that case, you must elect to
have the minimum DC income tax amount withheld by completing the Tax Withholding section.
• If your entire distribution amount has already been taxed (for instance only after-tax or nondeductible contributions
were made and you have no pre-tax earnings), you may be eligible to elect any of the withholding options.
• If you wish to take a distribution of both taxable and nontaxable amounts, you must complete a separate
distribution request form for each and complete the Tax Withholding section of the forms, as appropriate.
ME,
†
MS
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate unless you request otherwise.
• If you do NOT choose federal withholding, state withholding will occur unless you request otherwise.
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate.
OH
• State tax withholding is voluntary. If you choose state withholding, you can choose a higher rate than
your state’s minimum but not a lower rate.
SC
• SC requires state withholding if you have not provided a Tax ID or if you have been notified of a name/
Tax ID mismatch and have not resolved the issue. Otherwise, state tax withholding is voluntary and you can
choose the rate you want.
All other states
(and DC if not taking a
full distribution)
• State tax withholding is voluntary and you can choose the rate you want.
*When taking a single distribution.
†
When taking periodic distributions.
Important: Federal and/or state tax withholding rules can change, and the information cited above may not reflect the current legislation
and/or ruling of your state. Consult with your tax advisor, the IRS, or your state taxing authority to obtain the most up-to-date information
pertaining to your situation.
This tax information is for informational purposes only, and should not be considered legal or tax advice. Always consult a tax or legal
professional before making financial decisions.
We do not provide tax or legal advice and we will not be liable for any decisions you make based on this or other general tax information
we provide.
Fidelity Brokerage Services LLC, Member NYSE, SIPC; National Financial Services LLC, Member NYSE, SIPC 671710.8.0 (01/24)
Page 3 of 3
1.9585653.107
Page 1 of 5
Special Tax Notice Regarding Retirement
Plan Payments — Your Rollover Options
You are receiving this notice because all or a portion of a payment you are receiving from the___________________________[INSERT
NAME OF PLAN] (the “Plan”) is eligible to be rolled over to an IRA or an employer plan. This notice is intended to help you decide
whether to do such arollover.
This notice describes the rollover rules that apply to payments from the Plan that are not from a designated Roth account (a type of
account with special tax rules in some employer plans). If you also receive a payment from a designated Roth account in the Plan,
you will be provided a different notice for that payment, and the Plan Administrator or the payor will tell you the amount that is
being paid from each account.
Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules
that only apply in certain circumstances are described in the “Special Rules and Options” section.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollover affect my taxes?
You will be taxed on a payment from the Plan if you do not
roll it over. If you are under age 59½ and do not do a roll-
over, you will also have to pay a 10% additional income tax
on early distributions (generally, distributions made before
age 59½), unless an exception applies. However, if you
do a rollover, you will not have to pay tax until you receive
payments later and the 10% additional income tax will not
apply if those payments are made after you are age 59½ (or if
an exception applies). If you do a rollover to a Roth IRA, any
amounts not previously included in your income will be taxed
currently (see the section below titled “If you roll over your
payment to a Roth IRA”).
What types of retirement accounts and plans may
accept my rollover?
You may roll over the payment to either an IRA (an individual
retirement account or individual retirement annuity) or an
employer plan (a tax-qualified plan, section 403(b) plan, or
governmental section 457(b) plan) that will accept the rollover.
The rules of the IRA or employer plan that holds the rollover
will determine your investment options, fees, and rights to
payment from the IRA or employer plan (for example, no
spousal consent rules apply to IRAs and IRAs may not provide
loans). Further, the amount rolled over will become subject to
the tax rules that apply to the IRA or employer plan.
How do I do a rollover?
There are two ways to do a rollover. You can do either a
direct rollover or a 60-day rollover.
If you do a direct rollover, the Plan will make the payment
directly to your IRA or an employer plan. You should contact
the IRA sponsor or the administrator of the employer plan for
information on how to do a direct rollover.
If you do not do a direct rollover, you may still do a rollover
by making a deposit into an IRA or eligible employer plan
that will accept it. Generally, you will have 60 days after you
receive the taxable payment to make the deposit. If you
do not do a direct rollover, the Plan is required to withhold
20% of the taxable payment for federal income taxes (up
to the amount of cash and property received other than
employer stock). This means that, in order to roll over the
entire payment in a 60-day rollover, you must use other funds
to make up for the 20% withheld. If you do not roll over the
entire amount of the payment, the portion not rolled over will
be taxed and will be subject to the 10% additional income
tax on early distributions if you are under age 59½ (unless an
exceptionapplies).
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of
the amount eligible for rollover. Any payment from the Plan
is eligible for rollover, except:
• Certain payments spread over a period of at least 10 years
or over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary);
• Required minimum distributions after age 70½ (if you were
born before July 1, 1949), after age 72 (if you were born
after June 30, 1949), after age 73 (if you were born after
December 31, 1950), or after death;
• Hardship distributions;
• ESOP dividends;
• Corrective distributions of contributions that exceed tax law
limitations;
• Loans treated as deemed distributions (for example, loans
in default due to missed payments before your employment
ends);
• Cost of life insurance paid by the Plan;
• Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the first
contribution;
• Amounts treated as distributed because of a prohibited
allocation of S corporation stock under an ESOP (also, there
will generally be adverse tax consequences if you roll over a
distribution of S corporation stock to an IRA);
• Distributions for premiums of accident and health
insurance; and
1.820513.112
• Qualified birth or adoption distributions from an eligible
retirement plan or IRA. However, all, or a portion, of the
original distribution may be repaid to an eligible retirement
plan or IRA within the first three years following the original
distribution.
The Plan Administrator or the payor can tell you what portion
of a payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10%
additional income tax on early distributions?
If you are under age 59½, you will have to pay the 10%
additional income tax on early distributions for any payment
from the Plan (including amounts withheld for income tax)
that you do not roll over, unless one of the exceptions listed
below applies. This tax applies to the part of the distribution
that you must include in income and is in addition to the
regular income tax on the payment not rolled over.
The 10% additional income tax does not apply to the
following payments from the Plan:
• Payments made after you separate from service if you will
be at least age 55 in the year of the separation;
• Payments from a pension, profit sharing, or 401(k) plan after
you attain age 59½;
• Payments that start after you separate from service if
paid at least annually in equal or close to equal amounts
over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary);
• Payments from a governmental plan made after you separate
from service if you are a qualified public safety employee and
you will be at least age 50 in the year of separation;
• Payments made due to disability;
• Payments after your death;
• Payments of ESOP dividends;
• Corrective distributions of contributions that exceed tax
lawlimitations;
• Cost of life insurance paid by the Plan;
• Payments made directly to the government to satisfy a
federal tax levy;
• Payments made under a qualified domestic relations
order(QDRO);
• Payments up to the amount of your deductible medical
expenses (without regard to whether you itemize
deductions for the taxable year);
• Certain payments made while you are on active duty if you
were a member of a reserve component called to duty after
September 11, 2001, for more than 179 days;
• Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the
firstcontribution;
• Payments excepted from the additional income tax by
federal legislation relating to certain emergencies and due
to major disasters that are located in a qualified disaster
area as declared by the president of the United States
under section 401 of the Robert T. Stafford Disaster Relief
and Emergency Assistance Act;
• Phased retirement payments made to federal employees
• Payments of up to $5,000 (in aggregate) made to you from
a defined contribution plan if the payment is a qualified
birth or adoption distribution;
• Payments from a retirement plan if you are a qualified
public safety employee who provides firefighting services
(even if you are not employed in the public sector); or
a public safety officer or a corrections officer, after you
separate from service after attaining age 50, or if you have
more than 25 years of service under the plan;
• Payments from a retirement plan made to you after the
date certified by a physician that you have a terminal illness
or physical condition that can reasonably be expected to
result in death in 84 or fewer months;
• Payments of up to $22,000 made in connection with
federally declared disaster;
• Eligible payments to a domestic abuse victim that are made
within one year of the date on which you are a victim of
domestic abuse by a spouse or domestic partner (available
only for payments made on or after January 1, 2024);
• Payments from a qualified retirement plan, other than a
defined benefit plan, made to you for emergency personal
or family emergency expenses due to unforeseeable or
immediate financial needs that are necessary (available only
for payments made on or after January 1, 2024); and
• Payments of premiums for certified long-term care
insurance for you, your spouse, or eligible family members
subject to the annual limit, which is the lesser of the
amount paid for the coverage, 10% of your vested account
balance in the plan, or $2,500 as indexed (available only for
payments made after December 29, 2025).
If I do a rollover to an IRA (including a Roth IRA),
will the 10% additional income tax apply to early
distributions from the IRA?
If you receive a payment from an IRA (including a Roth IRA;
see section below titled, “If you roll over your payment to
a Roth IRA”) when you are under age 59½, you will have to
pay the 10% additional income tax on early distributions on
the part of the distribution that you must include in income,
unless an exception applies. In general, the exceptions to
the 10% additional income tax for early distributions from
an IRA are the same as the exceptions listed above for
early distributions from a plan. However, there are a few
differences for payments from an IRA, including:
• The exception for payments made after you separate
from service if you will be at least age 55 in the year of the
separation (or age 50 or following 25 years of service for
qualified public safety employees providing firefighting
services) does not apply.
Page 2 of 5
1.820513.112
Page 3 of 51.820513.112
• The exception for qualified domestic relations orders
(QDROs) does not apply (although a special rule applies
under which, as part of a divorce or separation agreement,
a tax-free transfer may be made directly to an IRA of a
spouse or former spouse).
• The exception for payments made at least annually in
equal or close to equal amounts over a specified period
applies without regard to whether you have had a
separation fromservice.
• The exception for payments of net income attributable to
an excess IRA contribution made in a calendar year where
such amounts are distributed by tax return deadline for the
year (including extensions), and no deduction is allowed
for the excess contribution.
• There are additional exceptions that apply to payments
from an IRA, including (1) payments for qualified higher
education expenses, (2) payments up to $10,000 used in
a qualified first-time home purchase, and (3) payments
for health insurance premiums after you have received
unemployment compensation for 12 consecutive weeks
(or would have been eligible to receive unemployment
compensation but for self-employed status).
Will I owe state income taxes?
This notice does not describe any state or local income tax
rules (including withholding rules).
SPECIAL RULES AND OPTIONS
If your payment includes after-tax contributions
After-tax contributions included in a payment are not taxed.
If a payment is only part of your benefit, an allocable portion
of your after-tax contributions is included in the payment, so
you cannot take a payment of only after-tax contributions.
However, if you have pre-1987 after-tax contributions
maintained in a separate account, a special rule may apply to
determine whether the after-tax contributions are included
in a payment. In addition, special rules apply when you do a
rollover, as described below.
You may roll over to an IRA a payment that includes after-
tax contributions through either a direct rollover or a 60-day
rollover. You must keep track of the aggregate amount of
the after-tax contributions in all of your IRAs (in order to
determine your taxable income for later payments from
the IRAs). If you do a direct rollover of only a portion of the
amount paid from the Plan and at the same time the rest
is paid to you, the portion directly rolled over consists first
of the amount that would be taxable if not rolled over. For
example, assume you are receiving a distribution of $12,000,
of which $2,000 is after-tax contributions. In this case, if you
directly roll over $10,000 to an IRA that is not a Roth IRA, no
amount is taxable because the $2,000 amount not directly
rolled over is treated as being after-tax contributions. If you
do a direct rollover of the entire amount paid from the Plan to
two or more destinations at the same time, you can choose
which destination receives the after-tax contributions.
Similarly, if you do a 60-day rollover to an IRA of only a
portion of a payment made to you, the portion rolled over
consists first of the amount that would be taxable if not rolled
over and the after-tax contributions are treated as rolled over
last. For example, assume you are receiving a distribution
of $12,000, of which $2,000 is after-tax contributions, and
no part of the distribution is directly rolled over. In this
case, if you roll over $10,000 to an IRA that is not a Roth
IRA in a 60-day rollover, no amount is taxable because the
$2,000 amount not rolled over is treated as being after-tax
contributions.
You may roll over to an employer plan all of a payment that
includes after-tax contributions, but only through a direct
rollover (and only if the receiving plan separately accounts
for after-tax contributions and is not a governmental
section 457(b) plan). You can do a 60-day rollover to an
employer plan of part of a payment that includes after-tax
contributions, but only up to the amount of the payment that
would be taxable if not rolled over.
If you miss the 60-day rollover deadline
Generally, the 60-day rollover deadline cannot be extended.
However, the IRS has the limited authority to waive the dead-
line under certain extraordinary circumstances, such as when
external events prevented you from completing the rollover
by the 60-day rollover deadline. Under certain circumstances,
you may claim eligibility for a waiver of the 60-day rollover
deadline by making a written self-certification. Otherwise, to
apply for a waiver from the IRS, you must file a private letter
ruling request with the IRS. Private letter ruling requests
require the payment of a nonrefundable user fee. For more
information, see IRS Publication 590-A, Contributions to
Individual Retirement Arrangements (IRAs).
If your payment includes employer stock that you
do not roll over
If you do not do a rollover, you can apply a special rule to
payments of employer stock (or other employer securities)
that are either attributable to after-tax contributions or paid
in a lump sum after separation from service (or after age
59½, disability, or the participant’s death). Under the special
rule, the net unrealized appreciation on the stock will not
be taxed when distributed from the Plan and will be taxed
at capital gain rates when you sell the stock. Net unrealized
appreciation is generally the increase in the value of
employer stock after it was acquired by the Plan. If you do
a rollover for a payment that includes employer stock (for
example, by selling the stock and rolling over the proceeds
within 60 days of the payment), the special rule relating
to the distributed employer stock will not apply to any
subsequent payments from the IRA or, generally, the Plan.
The Plan Administrator can tell you the amount of any net
unrealized appreciation.
Page 4 of 51.820513.112
If you were born on or before January 1, 1936
If you were born on or before January 1, 1936, and receive a
lump-sum distribution that you do not roll over, special rules
for calculating the amount of the tax on the payment might
apply to you. For more information, see IRS Publication 575,
Pension and Annuity Income.
If you roll over your payment to a Roth IRA
If you roll over a payment from the Plan to a Roth IRA, a
special rule applies under which the amount of the payment
rolled over (reduced by any after-tax amounts) will be
taxed. In general, the 10% additional income tax on early
distributions will not apply. However, if you take the amount
rolled over out of the Roth IRA within the 5-year period that
begins on January 1 of the year of the rollover, the 10%
additional income tax will apply (unless an exception applies).
If you roll over the payment to a Roth IRA, later payments from
the Roth IRA that are qualified distributions will not be taxed
(including earnings after the rollover). A qualified distribution
from a Roth IRA is a payment made after you are age 59½
(or after your death or disability, or as a qualified first-time
homebuyer distribution of up to $10,000) and after you have had
a Roth IRA for at least 5 years. In applying this 5-year rule, you
count from January 1 of the year for which your first contribution
was made to a Roth IRA. Payments from the Roth IRA that are
not qualified distributions will be taxed to the extent of earnings
after the rollover, including the 10% additional income tax on
early distributions (unless an exception applies). You do not have
to take required minimum distributions from a Roth IRA during
your lifetime. For more information, see IRS Publication 590-A,
Contributions to Individual Retirement Arrangements (IRAs), and
IRS Publication 590-B, Distributions from Individual Retirement
Arrangements (IRAs).
If you are not a plan participant
Payments after death of the participant. If you receive a
distribution after the participant’s death that you do not roll
over, the distribution will generally be taxed in the same
manner described elsewhere in this notice. However, the
10% additional income tax on early distributions and the
special rules for public safety officers do not apply, and the
special rule described under the section “If you were born
on or before January 1, 1936” applies only if the deceased
participant was born on or before January 1, 1936.
If you are a surviving spouse. If you receive a payment
from the Plan as the surviving spouse of a deceased
participant, you have the same rollover options that the
participant would have had, as described elsewhere in this
notice. In addition, if you choose to do a rollover to an IRA,
you may treat the IRA as your own or as an inherited IRA.
An IRA you treat as your own is treated like any other IRA
of yours, so that payments made to you before you are
age 59½ will be subject to the 10% additional income tax
on early distributions (unless an exception applies) and
required minimum distributions from your IRA do not have
to start until after you are age 70½ (if you were born before
July 1, 1949), age 72 (if you were born after June 30, 1949),
or age 73 (if you were born after December 31, 1950).
If you treat the IRA as an inherited IRA, payments from the
IRA will not be subject to the 10% additional income tax on
early distributions. However, if the participant had started
taking required minimum distributions, you will have to
receive required minimum distributions from the inherited
IRA. If the participant had not started taking required
minimum distributions from the Plan, you will not have to start
receiving required minimum distributions from the inherited
IRA until the year the participant would have been age 70½
(if he or she was born before July 1, 1949), age 72 (if he or
she was born after June 30, 1949), or the later of the year
that the participant would have attained age 73 (if the
participant was born after December 31, 1950), or the year
that you attain age 73 (if you attained age 72 after January 1,
2023).
If you are a surviving beneficiary other than a spouse. If you
receive a payment from the Plan because of the participant’s
death and you are a designated beneficiary other than a
surviving spouse, the only rollover option you have is to do a
direct rollover to an inherited IRA. Payments from the inherited
IRA will not be subject to the 10% additional income tax on
early distributions. You will have to receive required minimum
distributions from the inherited IRA.
Payments under a qualified domestic relations order (“QDRO”)
If you are the spouse or former spouse of the participant
who receives a payment from the Plan under a QDRO, you
generally have the same options and the same tax treatment
that the participant would have (for example, you may roll
over the payment to your own IRA, Roth IRA, or an eligible
employer plan that will accept it). However, payments under
the QDRO will not be subject to the 10% additional income
tax on early distributions (see the section titled “If you roll
over your payment to a Roth IRA” above).
If you are a nonresident alien
If you are a nonresident alien and you do not do a direct rollover
to a U.S. IRA or U.S. employer plan, instead of withholding 20%
of the taxable amount, the Plan is generally required to withhold
30% of the taxable amount of the payment for federal income
taxes. If the amount withheld exceeds the amount of tax you owe
(as may happen if you do a 60-day rollover), you may request
an income tax refund by filing Form 1040NR and attaching
your Form 1042-S. See Form W-8BEN for claiming that you are
entitled to a reduced rate of withholding under an income tax
treaty. For more information, see also IRS Publication 519, U.S.
Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities.
Other special rules
If a payment is one in a series of payments for less than 10
years, your choice whether to make a direct rollover will apply
to all later payments in the series (unless you make a different
choice for later payments).
1.820513.112 Page 5 of 5
If your payments for the year are less than $200 (not including
payments from a designated Roth account in the Plan), the
Plan is not required to allow you to do a direct rollover and is
not required to withhold for federal income taxes. However,
you may do a 60-day rollover.
Unless you elect otherwise, a mandatory cashout of more
than $1,000 (not including payments from a designated Roth
account in the Plan) will be directly rolled over to an IRA
chosen by the Plan Administrator or the payor. A mandatory
cashout is a payment from a plan to a participant made
before age 62 (or normal retirement age, if later) and without
consent, where the participant’s benefit does not exceed
$7,000 (not including any amounts held under the Plan as a
result of a prior rollover made to the Plan).
You may have special rollover rights if you recently served
in the U.S. Armed Forces. For more information on special
rollover rights related to the U.S. Armed Forces, see IRS
Publication 3, Armed Forces’ Tax Guide. You also may have
special rollover rights if you were affected by a federally
declared disaster (or similar event), or if you received a
distribution on account of a disaster. For more information
on special rollover rights related to disaster relief, see the IRS
website at www.irs.gov.
FOR MORE INFORMATION
You may wish to consult with the Plan Administrator or payor,
or a professional tax advisor, before taking a payment from
the Plan. Also, you can find more detailed information on
the federal tax treatment of payments from employer plans
in: IRS Publication 575, Pension and Annuity Income; IRS
Publication 590-A, Contributions to Individual Retirement
Arrangements (IRAs); IRS Publication 590-B, Distributions
from Individual Retirement Arrangements (IRAs); and IRS
Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans).
These publications are available from a local IRS office, on
the web at www.irs.gov, or by calling 1-800-TAX-FORM.
Accounts carried by Fidelity Brokerage Services LLC and National Financial Services LLC, Members NYSE, SIPC.
1.820513.112 — 452034.11.0 (01/24)
Questions? Go to Fidelity.com/security/overview or call 800-343-3548.
Let’s Talk about Protecting Your Money
A wire transfer is an easy, convenient way to send money to people you know. If you provide your information or send money to a scammer,
though, there is often little we can do to help get your money back. Here are some examples of common scams, things to ask yourself
before sending any funds, and what to do next if faced with one of these scams. Remember, in EVERY scenario, the first step is to STOP
communicating with the person immediately!
Romance Scam
What is it? A romance scam is a fraudulent scheme in which a fraudster pretends romantic interest in a target, establishes a relationship,
and then attempts to get money or personal sensitive information from the target under false pretenses.
What to do next if you suspect you’re a victim:
• Talk to someone you trust about your new relationship.
• Do a reverse image search of the person’s picture to see if it’s associated with another name or if the details don’t match.
Grandparent Scam
What is it? A scammer calls or emails you, posing as either a relative in distress or someone claiming to represent the relative (such as a
lawyer or law enforcement agent). The caller explains that the “relative” is in trouble and needs them to wire funds “immediately” for bail
money, lawyer’s fees, hospital bills, or another fictitious expense.
What to do next if you suspect you’re a victim:
• Call the relative (or their parent) directly, at their known phone number.
• If told you have to act quickly, resist that urge.
• Verify, verify, verify!
Sweepstakes/Inheritance Scam
What is it? You receive a notice stating that you’ve won a “big prize” or have received an unexpected inheritance. You’re told that in order
to claim the “prize” or “inheritance,” you need to send funds to cover “processing fees” or “taxes.” Once the money is sent, you never see
your prize or inheritance.
What to do next if you suspect you’re a victim:
• Independently verify the information by consulting reputable resources. Do not rely on resources the scammer gives you, since they are
probably involved in the scam as well.
• Remember, you cannot win a sweepstakes you never entered!
Investment Scam
What is it? An investment scam involves the illegal or purported sale of a financial instrument. The typical investment scam is characterized
by offers of low or no-risk investments, guaranteed returns, etc.
What to do next if you suspect you’re a victim:
• Don’t trust a person or company just because they have a website; a convincing website can be set up quickly.
• Be cautious when responding to special investment offers, especially through unsolicited email.
• Check with other resources regarding this person or company, and inquire about all the terms and conditions.
Watch for red flags Here are some examples of red flags that should make you think twice before sending money.
• A person or company solicits business from you rather than your finding them on your own.
• The requestor asks you to send the wire to a name different from their own.
• After just a few contacts, they profess strong feelings for you and ask to chat with you.
• They threaten legal action if the funds are not sent “right away.”
• The wiring instructions seem unusual, they change, or you’re asked to go to a different financial institution.
• You are coached on how to respond to questions your financial institution might ask you regarding the transaction.
• If you met on a dating site, they will try and move you away from the site and communicate via chat or email instead.
• Messages may be full of typing errors, poorly written, or vague, and may escalate quickly if you show resistance.
• The messages or calls become more desperate and/or persistent, and if you do send money, they ask you to send more.
Remember, if it seems too good to be true, it probably is!
Your security is our top priority. We’re here to help. If you have any concerns or want to know more about how to help protect yourself, talk to a
Fidelity representative or visit Fidelity’s Security Center online at Fidelity.com/security/overview. 928234.1.0 (05/20)
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