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Questions? Go to Fidelity.com/beneficiary or call 800-343-3548.
Beneficiaries Nonretirement Transfer on Death
Use this form to establish or update the beneficiaries on a Transfer on Death (TOD) registration on your nonretirement Fidelity Account
or Fidelity Funds Account registered as Individual, Joint Tenants with Rights of Survivorship, or Tenants by the Entirety. Do NOT use for
retirement accounts or 529 College Savings Plans. Type on screen or print out and 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
This form preempts any terms in your will concerning
the accounts in question. You may want to review this
document with a tax, financial, or legal adviser.
Transfer on Death registrations are not available
in Louisiana. Please consider consulting an attorney,
tax professional, or estate planner familiar with your
particular situation.
ALL account owners must sign this form.
Please read and review the Designated Beneficiary
Agreement attached at the end of this form.
Tenants-in-common cannot have TOD registrations.
This form cancels any existing beneficiary information.
Be sure this form includes ALL beneficiaries you want on
the account(s).
You can change beneficiaries any time at Fidelity.com/
beneficiary. To add or change beneficiaries on other
types of accounts, go to Fidelity.com/forms.
1. Account Owner
Name
Additional Name(s)
Daytime Phone Extension
2. Accounts Included
For new accounts, attach a copy of account opening form instead of listing account numbers below.
Fidelity Account Number Fidelity Account Number Fidelity Account Number
Fidelity Account Number Fidelity Account Number Fidelity Account Number
This phone number will
be used if we have
questions, but will not
be used to update your
account information.
List all accounts you
want this form to
apply to. To indicate
different beneficiaries
for different accounts,
use copies of this form.
1.925788.104 002070601
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Page 2 of 51.925788.104 002070602
3. Beneficiaries
Primary Beneficiaries
Spouse
Non-Spouse
Name If naming spouse as a beneficiary, do so here.
Trust
Other Entity
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Total must add up to 100%.
%
Contingent Beneficiaries
Spouse
Non-Spouse
Name If naming spouse as a beneficiary, do so here.
Trust
Other Entity
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust
MM DD YYYY Share Percentage
Per stirpes
%
Non-Spouse
Trust
Other Entity
Name
Social Security or Taxpayer ID Number Date of Birth/Trust MM DD YYYY Share Percentage
Per stirpes
%
Total must add up to 100%.
%
For each beneficiary
you list, check a
beneficiary type and
provide all information,
including the full first
and last name as
evidenced by a govern-
ment-issued, unexpired
document (e.g., driver’s
license, passport, per-
manent resident card).
If you outlive a
beneficiary and you
want that beneficiary’s
share to go to his or her
descendants, check
“Per stirpes.
Contingent beneficiaries
receive assets only if no
primary beneficiary
survives you.
Do NOT list any primary
beneficiaries here.
If you outlive a
beneficiary and you
want that beneficiary’s
share to go to his or her
descendants, check
“Per stirpes.
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Page 3 of 51.925788.104 002070603
4. Signature(s) and Date(s) ALL account owners must sign and date.
In this form, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC, Fidelity Distributors Company LLC, and National Financial
Services LLC and their affiliates, and their employees, agents, representatives, shareholders, successors, and assigns as the context may
require; and “You,” “you,” and “your” refer to all account holders, including individual, joint, trustees, and/or custodians.
By signing below, you:
Affirm that the beneficiary information
provided on this form replaces any prior
beneficiary information that may be on
record for the indicated account(s).
Affirm that you have received, read,
understood, and agree to be bound by
the terms and conditions in the attached
Designated Beneficiary Agreement and
this form, as is currently in effect and
as may be amended in the future. The
Designated Beneficiary Agreement and
this form shall inure to the benefit of
Fidelity’s successors and assigns, whether
by merger, consolidation, or otherwise.
Acknowledge that, if you check “per
stirpes,” that any share otherwise payable
to a beneficiary shall instead be paid to
that beneficiary’s surviving descendants by
right of representation if the original benefi-
ciary does not survive the account owner(s).
Acknowledge that “per stirpes” creates a
category of beneficiaries (for example, the
children of a beneficiary), and therefore
may end up including individuals not yet
born or adopted.
Acknowledge that listing beneficiaries
by name does NOT create a category of
beneficiaries, and that if you later want to
include other beneficiaries, you will need
to submit a new beneficiary form.
Acknowledge that if you do not provide per-
centages, the account will be divided equally
among primary beneficiaries or among con-
tingent beneficiaries, as applicable.
Agree that Fidelity has no obligation
to locate or notify any beneficiary or to
independently verify any information
submitted by any person claiming an
interest in your account.
Agree that when your assets are distrib-
uted to your beneficiaries, fractional shares
that cannot be distributed in accordance
with your instructions will instead be given
to the beneficiary receiving the largest per-
centage of the account’s assets or, if each
beneficiary is receiving an equal percent-
age, to the last paid beneficiary.
PRINT OWNER NAME
OWNER SIGNATURE TODAY’S DATE MM/DD/YYYY
SIGN
X X
PRINT ADDITIONAL OWNER NAME
ADDITIONAL OWNER SIGNATURE TODAY’S DATE MM/DD/YYYY
SIGN
X X
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 574792.4.0 (05/20)
Did you sign the form? Send the ENTIRE form to Fidelity. You will receive
a “Revised Account Profile” confirming your updates.
Questions? Go to Fidelity.com/beneficiary or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0002
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
0020706041.925788.104 Page 4 of 5
Beneficiaries Nonretirement Transfer on Death
Designated Beneficiary Agreement Keep this for your records.
This Agreement creates a transfer on death (“TOD”) registration
for an account upon the death of an individual account holder
or of the last surviving account holder in eligible joint accounts
(“Date of Death”) of a nonretirement Fidelity Account or Fidelity
Funds Account (the “Account”). The disposition of assets held in
the Account is controlled by the terms of this agreement and the
Beneficiaries—Nonretirement Transfer on Death Form (the “Form”),
which is incorporated into this agreement by reference (collectively,
the “Agreement”). “Fidelity” as used herein refers collectively to
Fidelity Brokerage Services LLC, Fidelity Distributors Company LLC,
and National Financial Services LLC. The assets in the Account
subject to the Agreement (“eligible assets”) will be transferred to
beneficiaries designated in the Form. The term “account holder”
means an individual account owner and, in the case of an eligible
joint Account, means each account holder or the last surviving joint
owner as indicated by the context. References to the estate of the
account holder shall mean the estate of the last surviving account
holder. The beneficiary designation and disposition of assets made
under the Agreement will take precedence over any disposition
contained in other documents such as a will, trust, premarital or
other legal document, even if specific reference is made therein to
the Agreement or to one or more specific Accounts, or any oral or
written agreement as to the disposition of eligible assets, except
by court order received by Fidelity in time for it to act before it
makes transfers under the Agreement. Fidelity does not give legal
or tax advice in connection with the Agreement, and account hold-
ers are advised to consult with their legal, tax, financial and estate
planning professionals before making any beneficiary designation.
Fidelity has not advised, nor is it obliged to advise, account owners
as to the suitability of the Agreement for the account holder. This
Agreement does not constitute a trust, and Fidelity has no fiduciary
duty as a trustee under the Agreement to the account holder, any
beneficiary under the Agreement or any other third party.
The Agreement supplements and does not replace any of the
terms and conditions of the applicable Customer Agreement for
the Account, a fund prospectus or any other terms and conditions
between the account holder and Fidelity that apply to the Account.
If the Agreement should conflict with any such other terms and
conditions, the Agreement will control. The Agreement may be
amended from time to time by Fidelity by written notice to the
account holder and the terms of the Agreement in effect at the
death of the last surviving account holder will control the disposition
of eligible assets under the Agreement.
While any account holder is living, Fidelity reserves the right to ter-
minate the Account, to revoke the Agreement and to require that
assets held in an Account be transferred to an account to which the
Agreement does not apply.
Fidelity may refuse to accept any beneficiary designation made by
an account holder under the Agreement. Certain assets, including,
but not limited to, any insurance, endowment policy or annuity con-
tract, are ineligible for the Agreement (“ineligible assets”). Limited
partnership interests may be ineligible assets due to a partnership
agreement or transfer agent conditions. Fidelity disclaims all liability
for a failure to transfer any ineligible assets. If an Account should
hold ineligible assets at the Date of Death and the disposition of
these ineligible assets is not governed by an agreement or contract
specifically related to the ineligible assets, the ineligible assets will
be paid to the estate of the account holder.
A. Eligibility for the Agreement In order to be eligible for TOD
registration, an account must be a registered individual or eligible joint
Account (i.e., joint tenants with rights of survivorship, or tenants by the
entirety). Accounts with any other registration (“ineligible accounts”)
must be changed to an eligible Account to qualify for TOD registra-
tion. If an eligible Account is changed from an individual registration
to a joint registration or if an eligible Account is changed to an ineli-
gible account, the Agreement is terminated as of the date of such
re-registration and upon the Date of Death all assets in the Account
will be paid to the estate of the account holder.
B. Effective Date The effective date of the Agreement is when
the Form is signed by the account holder (“Effective Date”). The
Form must be received and accepted by Fidelity no later than thirty
(30) days after the Date of Death of the account holder. Fidelity may
re-register the Account and dispose of the assets at any time after it
has accepted the Form. Any Form that is not signed and dated by
the account holder will not be accepted.
C. Determination of Beneficiaries The term “per stirpes”
means that if any primary or contingent beneficiary dies before the
account holder but has surviving descendants, that beneficiary’s
share is paid to such surviving descendants by right of representa-
tion. If the account holder designates beneficiaries as per stirpes,
persons within that group of descendants living on the Effective
Date and on the Date of Death are included. Such group of descen-
dants may end up including individuals not yet born, adopted, or
otherwise a member of the group on the Effective Date. Otherwise,
only named beneficiaries will share in the Account assets, and
others who may be in the same group of descendants as named
individuals (e.g., other children or grandchildren) but who are not
named will not share in the Account assets whether they were born,
adopted or otherwise became a member of the group before or
after the Effective Date. Only beneficiaries living on the Date of
Death are eligible to receive Account assets. Fidelity is authorized
to rely on any representation of facts made by the account holder,
the personal representative of the estate of the account holder, any
beneficiary, or any other person or source deemed appropriate by
Fidelity in determining the identity of unnamed beneficiaries.
If a non-person (e.g., a trust or corporation) is named as a benefi-
ciary and it is not in effect or in existence on the Date of Death,
it will be deemed not to have survived the account holder. To
establish facts related to the Account, including the time and dates
of death, Fidelity may rely on public records, including a death
certificate and other information furnished to it by a beneficiary, the
personal representative of the estate of the account holder, or any
other source deemed appropriate by Fidelity.
If your beneficiary allocation totals at least 99%, but less than 100%
(e.g., 3 named beneficiaries are each assigned a 33% interest in the
account), Fidelity will assign the unallocated remainder to the first
named beneficiary.
If the account holder has not designated the beneficiaries for any
portion of the eligible assets for any reason, including but not
limited to the percentages of eligible assets total less than 100%,
or because one or more beneficiaries is deceased on the Date of
Death, such eligible assets shall be distributed to the primary ben-
eficiaries who survive the account holder in the same proportion that
their original shares bear to each other or, if no primary beneficiary is
then living, such eligible assets shall be distributed to the contingent
beneficiaries who survived the account holder in the same propor-
tion that their original shares bear to each other. The term “primary
beneficiary” shall mean: (1) a named primary beneficiary; or (2)
descendants of a deceased named primary beneficiary for whom the
account holder has selected per stirpes. Distributions made because
the account holder has selected per stirpes shall be paid as follows:
Questions? Go to Fidelity.com/beneficiary or call 800-343-3548.
0020706051.925788.104 Page 5 of 5
the eligible assets are divided into as many equal shares as there
are living children of the account holder or designated named ben-
eficiary and deceased children of the account holder or designated
named beneficiary who have descendants living. Each living child
is allocated one share. The share of each deceased child with living
descendants is allocated one share, which is divided equally among
such living descendants. This subdivision is repeated at each suc-
ceeding generation until the property is fully allocated among living
descendants. For example, if per stirpes has been selected and if
the account holder at the Date of Death has two living children and
one deceased child who has three living children (i.e., grandchildren
of the account holder), each living child of the account holder would
receive one-third of the eligible assets and each of the three children
of the deceased child would receive one-ninth of the eligible assets.
Division among the descendants of a named beneficiary would occur
in the same manner as to the share of the named beneficiary. The
term “descendants” shall include both natural and legally adopted
descendants living at the Date of Death.
If no primary or contingent beneficiary is living on the Date of Death,
the Account assets will be paid to the estate of the account holder.
D. Changes to Beneficiary Designations The account holder
may at any time change the named beneficiaries or revoke the
designations made under the Agreement. A subsequent Form will
revoke a prior designation of beneficiaries when the Form becomes
effective (i.e., signed, delivered to, and accepted by Fidelity, and
submitted in a form and manner acceptable to Fidelity).
Except as provided with respect to descendants of the account
holder who become beneficiaries because the account holder has
selected per stirpes, changes in the relationship between the account
holder and any other beneficiary, including, but not limited to, sub-
sequent marriage, dissolution of marriage, remarriage or adoption,
will not automatically add or revoke designations of beneficiaries.
For example, if a former spouse was a designated beneficiary prior
to dissolution of the marriage, the former spouse would remain a
beneficiary after the dissolution unless his or her designation as
a beneficiary was expressly revoked by execution of a new Form
signed by the account holder and received and accepted by Fidelity.
E. Payment on Death Until the Date of Death, the account
holder retains complete control over the assets in the Account, the
beneficiaries have no interest in the Account, and there will be no
transfers made pursuant to the Agreement. All eligible assets in
the Account must be held at Fidelity at the Date of Death in order
to be distributed to beneficiaries. Fidelity may liquidate assets to
pay and transfers will be reduced by any financial obligation of the
account holder to Fidelity, including, but not limited to, any margin
debt balance or if the Account is subject to any taxes. Transfers shall
be increased by any amounts payable to the Account but not paid
or credited before the Date of Death. Unless otherwise instructed,
all income paid to the Account after the assets have been initially
apportioned (i.e., residual income) will be systematically allocated
to the beneficiary receiving the largest share proportion of the
account assets. If the account is transferred evenly, the income
and/or fractional shares will be systematically allocated to the last
beneficiary paid. Amounts paid or credited after Date of Death but
before Fidelity has had reasonable time to act following the account
holder’s death will be paid to the estate of the account owner.
Each designated beneficiary must notify Fidelity of the death of
the account holder and provide in a timely manner: (1) either the
account number of an existing Fidelity account of which the benefi-
ciary is an owner or a completed and signed Change of Registration
Form or new account application, as applicable (if not previously
provided); (2) a copy of the death certificate; (3) a tax waiver if
required by state law; and (4) such additional necessary and/or
appropriate information or documents as Fidelity may require.
Fidelity may require a certification of the identity of the beneficiaries
from the personal representative of the estate of the account holder
or any other appropriate person.
Fidelity will require each beneficiary to open an account at Fidelity
or to identify an appropriate existing Fidelity account in order to
facilitate transfer of the Account’s eligible assets and to execute an
indemnification in the amount of the Account’s assets.
Transfer of assets in the Account will begin as soon as practicable
after the Date of Death.
Fidelity has no obligation to: (1) locate any beneficiary, the spouse
or legal heirs of any account holder or the personal representative
of the estate of any account holder; (2) notify any person of any pro-
posed or completed transfer of eligible assets; or (3) independently
verify any information submitted by any person claiming an interest
in the Account.
In the event of reasonable doubt as to disposition of Account
assets, Fidelity may resolve such doubt by judicial determination,
which shall be binding on all parties claiming any interest in the
Account. All legal and other applicable expenses shall be paid from
the assets of the Account.
F. Payments to Minors and Other Beneficiaries Under
Incapacity If a beneficiary is a minor or otherwise under a legal
disability, Fidelity may, in its absolute discretion, make all, or any
part of the distribution for such beneficiary to: (1) a parent of such
beneficiary; (2) the guardian, conservator, or other legal repre-
sentative, wherever appointed, of such beneficiary; (3) an existing
custodial account established for such beneficiary under a Uniform
Transfers to Minors Act or similar act; (4) any person having control
or custody of such beneficiary; or (5) to such beneficiary directly. If
there is no person having control or custody or no existing custodial
account of such beneficiary, nor a court-appointed custodian or
guardian, Fidelity may request such appointment for the distribution
of any eligible assets payable to such beneficiary.
G. Indemnity The account holder, the estate and successors-
in-interest of the account holder, including all beneficiaries, shall
fully indemnify and hold harmless Fidelity, its agents, affiliates,
control persons, successors and assigns and their directors, officers,
employees and agents from and against all claims, actions, costs
and liabilities, including attorneys’ fees, by or to any person or
entity, including any beneficiary, any creditor of the account holder,
the estate of the account holder and the account holder’s heirs, suc-
cessors and assigns, arising out of or relating to:
Any designation of a beneficiary made under the Agreement that
conflicts with any beneficiary designation made in the account
holder’s will, trust, premarital agreement, other oral or written
agreement or any other legal document.
Any written change of beneficiaries by the account holder that has
not been received by and accepted by Fidelity.
Any other action taken by Fidelity in opening and maintaining the
Account under the Agreement, registering assets in the name of
the Account and completing transfers from the Account upon the
Date of Death, including, but not limited to, Fidelity’s reliance on
individuals or sources named in this Agreement.
H. Governing Law. This Agreement and its enforcement are gov-
erned by the laws of the Commonwealth of Massachusetts, except
with respect to its conflicts-of-law provisions. The Agreement shall
inure to the benefit of Fidelity’s successors and assigns, whether by
merger, consolidation or otherwise, and shall be binding upon the
heirs, personal representatives, successors and assigns of the account
holder and the beneficiaries designated by the account holder.