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Page 1 of 5
Questions? Go to Fidelity.com/pws or call 800-343-3548.
Automatic Withdrawals — Nonretirement
Use this form to establish, change, or delete an ongoing automatic withdrawal plan from your nonretirement Brokerage or Mutual Fund
Only Account. Do NOT use this form for retirement accounts, annuities, ABLE accounts, or 529 college savings plan accounts. Go to
Fidelity.com/forms to find the appropriate form. Type on screen or fill in using CAPITAL letters and black ink. If you need more room for
information or signatures, make a copy of the relevant page.
Helpful to Know
• To set up automatic withdrawal plans for more than one
account, complete a separate form for each account.
• To establish, change, or delete an earnings automatic
withdrawal plan, use the Earnings Automatic Withdrawal
Plan — Nonretirement form.
• 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 shares of the fund in the future if
you draw your fund balance down to zero.
• If you want to withdraw the value of individual securities,
ETFs, and certain non-eligible mutual funds (such as
closed-end funds), you must sell them in advance and
withdraw them as cash.
1. Account Owner(s)
Name Fidelity Account Number
Social Security or Taxpayer ID Number
2. Type of Request
ESTABLISH a new automatic withdrawal plan
CHANGE an existing automatic withdrawal plan
Details of Change
DELETE an existing automatic withdrawal plan
Skip to Section 6.
Plan to Be Deleted
Frequency and Amount of Withdrawals
Distribution payments may occur on the prior business day depending on market availability. Examples include payments that are scheduled
for a day when the stock market is closed or for a day that doesn’t exist in every month (29th–31st).
Withdrawal Amount:
Amount
$
.
Annually
Quarterly
Monthly
Payment begin date MM DD YYYY Payment end date MM DD YYYY Optional
Customized Schedule: Jan Feb Mar Apr May Jun
Jul Aug Sep Oct Nov Dec
Check one.
Optional.
Optional.
If you check this box,
select at least two
withdrawals per year.
1.753053.111 006490801
Form continues on next page.
Allow at least
4 business days
for Fidelity to
establish this
feature on your
account.
Print
Reset
Save
Page 2 of 5
3. Funding Your Withdrawal
You can choose to fund your distribution in one of two ways, as described below. If your distribution is from a Fidelity managed account,
skip to Section 4.
Fixed Amount/Percentage Distribution
Withdraw from the core position.
Default if no choice indicated.
Liquidate and withdraw from these positions in the amount or percentage listed:
Core Position or Fund Name/Number Amount
OR
Percentage
$
.0%
.
Core Position or Fund Name/Number Amount
OR
Percentage
$
.0%
.
Core Position or Fund Name/Number Amount
OR
Percentage
$
.0%
.
Core Position or Fund Name/Number Amount
OR
Percentage
$
.0%
.
Core Position or Fund Name/Number Amount
OR
Percentage
$
.0%
.
Total
must add up to 100%.
.0%
Secondary Withdrawal Instructions for Fixed Amount/Percentage Distributions:
Will be used if there are insufficient funds in the above core position or fund name(s)/number(s).
Any money market or core position
Any money market, bond fund, equity fund, or core position
Proportional Distributions
Withdrawals will be made from the Eligible Positions in the account identified in Section 1. Eligible Positions include your core position (for
brokerage accounts), all Fidelity mutual funds, and those non-Fidelity mutual funds available through Fidelity
®
FundsNetwork
®
where the
mutual fund company has agreed to make the fund(s) available for automatic withdrawals.
Distribute proportionally from all Eligible Positions in the account.
4. Withdrawal Method
You must obtain a Medallion signature guarantee in Section 6 if establishing EFT instructions for a bank account that is not in your name,
if sending a check to a payee other than the account owner or to an alternate address, if directly depositing the withdrawal into a Fidelity
account with no common owner, or if the per-payment amount is greater than $100,000.
Directly deposited into a Fidelity nonretirement brokerage account. Deposits will be made to the core position.
Fidelity Nonretirement Account Number
Directly deposited into a Fidelity nonretirement mutual fund account. The first three characters of the account number
are 2 followed by two letters (example: 2AB-123456).
Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol If applicable.
All funds listed must
be held in the account
listed in Section 1.
If no selection is
made, withdrawals
will be made from
the core position.
NOT applicable to
Fidelity managed
accounts.
Check one and
provide any required
information.
1.753053.111 006490802
Withdrawal Method continues on next page.
Page 3 of 51.753053.111 006490803
See “Important Information about Electronic Funds Transfer (EFT)” included with this form.
Electronic funds transfer (EFT) to a bank or credit union account. To add EFT to an account, go to Fidelity.com/eft or
provide your bank information below.
If EFT cannot be established for any reason, a check will be sent to your address of record.
A. EFT to your bank account. You must be an owner on the Fidelity account and the bank account. Provide
your account information below. You must attach a voided check, deposit slip, or bank statement with
the account number and all owner names preprinted on it.
Checking Savings
B. 3rd Party EFT to someone else. (Available for brokerage accounts only.) The names on the bank account
and the Fidelity account are different. This option ONLY allows you to move money TO the outside account
and may not be used to make transfers for commercial purposes. Provide the account information below.
A Medallion signature guarantee is required in Section 6.
Owner(s) Name(s) Exactly as on Bank Account
Bank Routing/ABA Number Bank Name
Checking or Savings Account Number
Check mailed to the address of record
Default if no choice indicated or if we are unable to process your choice.
Check paid to the account owner and mailed to an alternate address
Attention Address
City State/Province ZIP/Postal Code
5. W-8-Certified Customers (Non-U.S. Citizens) Explanation for standing instructions
requested for a different country from the country of tax residence.
If you are requesting standing instructions to send money to a financial institution in the United States or in a country different from the
treaty country listed on your W-8, provide the reason below.
Reason 250 characters maximum
If you ONLY have
one set of EFT
instructions already
established for the
account referenced
in Section 1, check
the box and skip to
Section 5. Otherwise,
complete the entire
section.
Provide bank
information ONLY if
establishing new EFT
instructions OR if you
have multiple EFT
instructions available
for the account refer-
enced in Section 1.
Required to be
completed if
applicable.
4. Withdrawal Method, continued
Form continues on next page.
1.753053.111 006490804Page 4 of 5
6. Signature(s) and Date(s) Form cannot be processed without signature(s) and date(s).
ALL businesses and entities must also complete Section 7.
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC and National Financial Services LLC and their affili-
ates, and their employees, agents, representatives, shareholders, successors, and assigns as the context may require; “you” and “account
owner” refer to the owner indicated on the account form; and for any account with more than one owner (such as a joint or trust account),
“you” and “account owner” or “account owners” refer to all owners, collectively and individually.
By signing below, you:
• Authorize and request Fidelity to make the
withdrawals indicated in this form from the
account indicated in this form.
• Acknowledge that this authorization may
only be revoked by providing notice of
revocation to Fidelity, in such time and
manner as to afford Fidelity and each bank
a reasonable opportunity to act upon it.
• Certify that all information provided in this
form is true, accurate, and complete.
Customers requesting EFT:
• Authorize and request Fidelity to make EFT
distributions from the Fidelity account listed
in this form by initiating debit entries to
such account.
• Authorize us, upon receiving instructions
from you or as otherwise authorized by
you, to make payments from you and
to you or to your designee, by credit or
debit entries to the designated account
at the financial institution named in this
form or the financial institution specified
in your existing instructions (the “Bank”).
You authorize the Bank to process
such entries and to credit or debit the
designated account at that Bank for such
entries. You ratify such instructions and
agree that neither we nor any mutual
fund will be liable for any loss, liability,
cost, or expense for acting upon all such
instructions believed to be genuine if we
employ reasonable procedures to prevent
unauthorized transactions. You agree that
this authorization may only be revoked
by written notice to us in such time and
manner as to afford us and the Bank a
reasonable opportunity to act upon it.
• Warrant and represent that (i) the third
party’s account identified in Section 4
is owned by a natural person, (ii) that
person has authorized his/her account
to be credited in accordance with your
instructions, and (iii) the account has
been established for personal, family, or
household use, and not for commercial
purposes.
• Acknowledge that you have read and
agree to the Important Information
about Electronic Funds Transfer (“EFT”)
document, if you have elected to use EFT.
• Understand that Fidelity may purge unused
EFT instructions from your account on a
periodic basis without notice to you.
• Understand that Fidelity may terminate the
EFT instructions from your account at any
time in its sole discretion.
For Trust Accounts:
• By signing as a trustee, you certify that you
have the power and authority under the
trust agreement and applicable law to enter
into all transactions, including purchases,
sales, and exchanges and redemptions of
mutual funds, and deliver any documents
necessary to open and maintain accounts on
behalf of the trust.
For Business Accounts, if you are the sole
officer, you:
• State that you are authorized to enter into
transactions in mutual fund shares on behalf
of the organization.
• State that you are the sole officer of, and the
sole individual authorized to act on behalf
of, the registered owner.
One authorized signature is required unless you have a Mutual Fund Account (the account number begins with a 2 followed by two
letters) in which case all owners must sign.
A Medallion signature guarantee is required:
• to establish EFT instructions for a bank account that is not in your name.
• if a check is being sent to an alternate address.
• if the withdrawal is going to a Fidelity account with no common owner.
• to request a per-payment amount greater than $100,000.
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. 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 OWNER NAME
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
Signature(s) and Date(s) 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. 468492.8.0 (05/20)
Did you sign the form? Send the ENTIRE form and
any attachments to Fidelity Investments. You will
receive a Revised Account Profile confirming your
withdrawal instructions.
Questions? Go to Fidelity.com/pws or
call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0002
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1B
Covington, KY 41015
1.753053.111 006490805Page 5 of 5
PRINT ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
7. Business/Entity Account Certification All businesses and entities must review this section.
If there is only one officer, that officer must sign in Section 6. If there is more than one officer, an authorized
individual other than those signing in Section 6 must also sign below in this Section 7.
By signing below, you:
• State that the individual(s) signing above is (are) authorized to enter into transactions in mutual fund shares on behalf of the organization.
• State if you are the same individual signing above, that you are the sole officer of, and the sole individual authorized to act on behalf of,
the registered owner.
A Medallion signature guarantee is required:
• if a check is being sent to an alternate address.
• if the withdrawal is going to a Fidelity account with no common owner.
• to request a per-payment amount greater than $100,000.
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. 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 OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
PRINT OWNER/AUTHORIZED INDIVIDUAL TITLE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
6. Signature(s) and Date(s), continued
Questions? Go to Fidelity.com/movemoney or call 800-343-3548.
Important Information about Electronic
Funds Transfer (EFT)
Keep this information for your records.
Privacy Statement
You understand that Fidelity will disclose information to third
parties about your account or the transfers you make:
(i) Where it is necessary for completing transfers, or
(ii) In order to verify the existence and condition of your account
for a third party, such as a credit bureau or merchant, or
(iii) In order to comply with a government agency or court order, or
(iv) If you give Fidelity your written permission, or
(v) For other purposes in accordance with Fidelity’s privacy statement
Fees
There is no fee to use the EFT service, although your financial
institution may charge transaction fees.
Limitations for EFTs
There may be a four-day period after Fidelity processes your request
to establish EFT, during which the service will be unavailable to
transfer funds to or from your bank account. The minimum amount
for EFTs initiated on Fidelity.com is $10 (or with respect to a Fidelity
mutual fund account, the fund minimum). In most cases, EFTs
initiated on Fidelity.com are subject to a maximum cumulative daily
amount of $100,000 for transfers out of your Fidelity account, and
$250,000 for deposits into your Fidelity account. Transfers out of
your Fidelity account initiated on Fidelity.com are typically limited
to three per day.
Brokerage Account Minimum Balances
There is no minimum account balance to process an EFT transaction;
however, your core account must have adequate funds to cover
a redemption.
Mutual Fund Account Minimum Balances
There is no minimum account balance to process an EFT transac-
tion; however, you must have an adequate balance in your mutual
fund position to cover a redemption.
Business Days
For purposes of EFTs, Fidelity’s business days are Monday through
Friday. Bank and New York Stock Exchange holidays are not included.
Documentation Periodic Statement
You will receive a monthly account statement from Fidelity, unless
there are no transactions in a particular month. In any case, you will
receive a statement quarterly.
Direct Deposits
I
f you have arranged to have direct deposits made to your Fidelity
Account or Fidelity Mutual Fund Account, at least once every sixty
(60) days from the same person or company, you can call Fidelity
at 800-343-3548 to find out whether or not the deposit has
been made.
Special Disclosure for Covered Transfers
In general, your use of the EFT service for transfer of funds
electronically other than those for which the primary purpose is
the purchase or sale of securities (“Covered Transfers”) is covered
under the Electronic Funds Transfer Act and the Bureau of Consumer
Financial Protection’s Regulation E and related laws and regulations.
The following terms and disclosures apply to Covered Transfers:
Unauthorized Transfers
You will tell Fidelity promptly if you believe your password has been
lost or stolen or may have been used without your permission.
Telephoning Fidelity at the number listed below is the best way of
keeping your possible losses down. If you believe your password has
been lost or stolen, and you tell Fidelity within two (2) business days
after you learn of the loss or theft, you can lose not more than $50
for Covered Transfers if someone used your password without your
permission. If you do NOT tell Fidelity within two (2) business days
after you learn of the loss or theft of your password, and Fidelity can
prove Fidelity could have prevented any unauthorized use if you had
told Fidelity, you could lose as much as $500. Also, if your statement
shows Covered Transfers that you did not make, you will tell Fidelity
promptly. If you do not tell Fidelity within sixty (60) days after the first
statement was mailed to you, you may not get back any money you
lost after sixty (60) days if Fidelity can prove that Fidelity could have
stopped someone from taking the money if you had told Fidelity in
time. In extenuating circumstances, Fidelity may extend such time
periods. Additional protection may be available from Fidelity for
specific accounts under certain circumstances.
Stop Payment Procedures
If you have told Fidelity in advance to make regular Covered
Transfers out of your Fidelity account, you can stop any of these
payments. Here’s how: you can call or write to Fidelity using the
contact information listed below. Your notice must be made in
time for Fidelity to receive your request at least three (3) business
days or more before the payment is scheduled to be made. If you
call, Fidelity may, as an additional measure, require you to put
your request in writing and get it to Fidelity within fourteen (14)
days after you call. Unless otherwise provided, you may not stop
payment of electronic funds transfers; therefore, you should not
employ electronic access for purchases or services unless you are
satisfied that you will not need to stop payment.
1.964554.104 Page 1 of 2
Fidelity’s Liability for Failure to Make
Covered Transfers
If Fidelity does not complete a Covered Transfer to or from your
Fidelity account on time or in the correct amount according to Fidelity’s
agreement with you, Fidelity may be liable for your losses or damages.
However, there are some exceptions. Fidelity will not be liable
for instance:
• If, through no fault of Fidelity’s, you do not have enough money in
your Fidelity account to make the Covered Transfer.
• If the money in your Fidelity account is subject to legal process or
other claim restricting such transfer.
• If the transfer would exceed your margin availability, if any.
• If the bank account information you provided to Fidelity when
you established the EFT service was incorrect or has subsequently
become incorrect.
• If circumstances beyond Fidelity’s control (such as fire or flood) pre-
vent the transaction, despite reasonable precautions taken by Fidelity.
• If there was a technical malfunction which was known to you at
the time you attempted to initiate a Covered Transfer or, in the
case of a preauthorized Covered Transfer, at the time the transfer
should have occurred.
• There may be other exceptions stated in our agreement with you.
Error Resolution
In the case of errors or questions about your Covered Transfers, you
will call or write Fidelity using the contact information listed below,
promptly. You will call or write Fidelity if you think your statement
is wrong or if you need more information about a Covered Transfer
on the statement. Fidelity must hear from you no later than sixty
(60) days after Fidelity sent the FIRST statement on which the
problem or error appeared. You will:
• Tell Fidelity your name and account number.
• Describe the error or the Covered Transfer that you are unsure
about, and explain as clearly as you can why you believe it is an
error or why you need more information.
• Tell Fidelity the dollar amount of the suspected error.
If you notify Fidelity orally, Fidelity may require that you send your
complaint or question in writing within ten (10) business days. Fidelity
will tell you the results of its investigation within ten (10) business
days after Fidelity hears from you and will correct any error promptly.
If Fidelity needs more time, however, it may take up to forty-five (45)
days to investigate your complaint or question. If Fidelity decides
to do this, it will credit your account within ten (10) business days
for the amount that you think is in error, so that you will have the
use of the money during the time it takes Fidelity to complete its
investigation. If Fidelity asks you to put your request or question in
writing and it does not receive it within ten (10) business days, or if
your account is a brokerage account subject to Regulation T of the
Board of Governors of the Federal Reserve System (Credit By Brokers
and Dealers, 12 CFR 220), Fidelity may not credit your account. For
questions involving new accounts, point of sale or foreign initiated
transactions, we may take up to ninety (90) days to investigate
your complaint or question. With respect to new accounts, we may
take up to twenty (20) business days to credit your account for the
amount you think is in error. Fidelity will inform you of the results
of its investigation within three (3) business days of its completion.
If Fidelity decides that there was no error, Fidelity will send you a
written explanation. You may ask for copies of the documents that
Fidelity used in the investigation.
Contact Information
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277
Phone: 800-343-3548
Representatives are available 24 hours per day, seven days per week,
to take your call.
Important Information, continued
1.964554.104 Page 2 of 2
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 652049.5.0 (11/19)
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