New Fidelity Account — Fidelity Inherited IRA
for a Non-Spouse Individual
Use this application if you are a non-spouse beneficiary of an IRA or a qualified retirement plan and the original account owner is
deceased and you need to open an Inherited IRA or Inherited Roth IRA. Type on screen or print out and fill in using CAPITAL letters
and black ink. If you need more room for information or signatures, use a copy of the relevant page.
Helpful to Know
• Uninvested money in your account is held in your core position – You represent an entity like a charity, university, or other edu-
until you direct otherwise. Your core position will be the Fidelity cational organization.
Government Money Market Fund, a money market mutual fund. – You are a successor beneficiary.
Note that other core position options may be available after you • Distribution rules for your Inherited IRA will be based on several
open your account. factors including the age of the original IRA owner at death and
• If the deceased was over 70½ and had not withdrawn his or her your age.
total minimum required distribution (MRD) in the year of death, – If the deceased IRA owner died before reaching 70½, the age
see Section 7. for mandatory MRDs, then you may elect to take distributions
• Use this form if you are a non-spouse individual over the age using either:
of 18. – the five-year rule; or
– annually, based on your age beginning by December 31 of
• Please use the Fidelity Inherited IRA for Minors/Non-Individuals the year following death
form if you are inheriting from the original owner and: – If the deceased IRA owner was 70½ or older and taking
– You are a minor or incapacitated person that is named as the annual MRDs at time of death, then annual MRDs must con-
beneficiary. tinue to be taken but will be calculated using either:
– Your intent is to open a Trust Inherited IRA. – the beneficiary’s own age and IRS Single Life Expectancy
– The deceased IRA owner’s or a deceased beneficiary’s estate table; or
is inheriting. – the remaining life expectancy of the deceased IRA owner
To learn more about these options, visit Fidelity.com.
1. Deceased IRA Owner’s Information Include a copy of deceased’s death certificate and a
state inheritance tax waiver, if required by the deceased’s state of residence.
First Name M.I. Last Name
Social Security Number Date of Birth MM DD YYYY Date of Death MM DD YYYY
2. Selection of Type of Account
Indicate the type of account you plan to establish. For more information about options available to you as an owner inheriting retirement
assets, go to Fidelity.com.
Establish a New Account
Inherited IRA
Inherited Roth IRA
Account owner must sign and date at the end of section 8. Form continues on next page.