Fillable Earnings Automatic Withdrawal Plan Nonret (Fidelity Investments)

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Earnings Automatic Withdrawal Plan Nonret (Fidelity Investments)

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Earnings Automatic Withdrawal
Plan — Nonretirement
Use this form to establish, change, or delete an earnings automatic withdrawal plan from your nonretirement Brokerage or Mutual Fund
Only account. Use one form for each account. Do NOT use this form for retirement accounts, workplace savings 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
• By setting up an earnings automatic withdrawal plan,
you may elect to have any earnings (such as dividends,
interest, and capital gains) on certain mutual funds and
eligible securities distributed to you.
• To establish an Earnings Automatic Withdrawal Plan, you
may have to change your current dividends and capital
gains instructions to remove reinvestment instructions for
any holding(s) from which you want an earnings distribu-
tion. To do so, log on to Fidelity.com/dividends.
• 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.
• Certain corporate actions such as a return of capital or
a tender offer may result in your account receiving unex-
pected earnings up to and including entire positions.
The Earnings Automatic Withdrawal Plan does not
distinguish between these unusual corporate actions
and more routine earnings your account receives. If
your account receives corporate action payments, your
withdrawal for the subsequent period would include the
amounts received.
• Drawing your total account balance down to zero could
trigger account-closing fees.
• For Mutual Fund Only accounts, the only schedule
option allowed is Daily.
• Earnings on the following securities are not eligible for
plan payout and must be reinvested:
– Fidelity Cash
– Fidelity Government Cash Reserves
– Fidelity U.S. Government Reserves
– Fidelity Select Money Market
– All eligible core money market funds
• For managed account programs sponsored by Fidelity
®
Personal and Workplace Advisors LLC, such as, but
not limited to, Fidelity
®
Wealth Services and Fidelity
®
Strategic Disciplines, earnings held pending distribution
are not subject to discretionary investment management.
1. Account Owner
Name Fidelity Account Number
Social Security or Taxpayer ID Number
2. Distribution Request
Type of Request
ESTABLISH a new earnings automatic withdrawal plan
CHANGE an existing earnings automatic withdrawal plan
Fill out ONLY sections with changes.
DELETE an existing earnings automatic withdrawal plan
Skip to Section 5.
Check one.
Questions? Go to Fidelity.com/autowithd or call 800-343-3548.
1.814424.115 Page 1 of 5 012371201
Distribution Request continues on next page.
Print
Reset
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1.814424.115 Page 2 of 5 012371202
Earnings Automatic Withdrawal Plan Instructions
Earnings pending distribution are treated as free credit balances pursuant to Rule 15c3-3 under the Securities Exchange Act of 1934. As such,
these amounts are not segregated and may be used in Fidelity’s business in accordance with applicable federal securities laws. Interest is
earned at a rate set by Fidelity in its sole discretion. Amounts pending distribution may not be protected by the Securities Investor Protection
Corporation (SIPC). You are entitled to these amounts upon demand.
Change existing dividends and capital gains instructions for the account specified above to have ALL mutual
funds’ dividends and capital gains and ALL eligible securities’ dividends, interest, and capital gains withdrawn
and held until the next date specified below for automatic distribution to you. Allow 3 to 5 business days for the
change to take effect. Only choice available for managed account programs.
Use existing dividends and capital gains instructions for the account specified above (accessible at Fidelity.com/
dividends) to have all eligible mutual funds’ and other securities’ dividends, interest, and capital gains, other than
those earnings specifically set to reinvest, withdrawn and held until the next date specified below for automatic
distribution to you. Default for accounts (except managed account programs) if no choice indicated.
Frequency of Earnings Automatic Withdrawal Plan Payments
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).
Daily (D) Payments will be made every business day. You cannot request checks sent by mail with this option.
Weekly (W) Payments will be made every Friday.
Monthly (M) Payments will be made on the last Friday of each month.
Semimonthly (S) Payments will be made on the second and last Friday of each month.
Quarterly (Q) Payments will be made on the last Friday of March, June, September, and December.
Weekly-PLUS (F) Payments will be made every Friday AND on the first business day following the 1st, 15th, and
22nd of each month.
Annual (A)
MM DD
Customized Schedule (X):
Every month
In the selected months of:
Jan Feb Mar Apr May Jun
Jul Aug Sep Oct Nov Dec
Day DD Day DD Day DD
Check one.
Check one.
If you check this box,
select at least two
withdrawals per year.
Form continues on next page.
2. Distribution Request, continued
1.814424.115 Page 3 of 5 012371203
3. Distribution Method
You must obtain a Medallion signature guarantee in Section 5 if establishing EFT instructions for a bank account that is not in your
name, or if sending a distribution to a payee other than the account owner or to an alternate address.
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. Account consists of a combination of nine num-
bers and letters (example: 2AB-123456).
Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol Mutual fund accounts ONLY.
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 5.
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
4. 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
Check one and
provide any required
information.
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 4. 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.
If you choose Daily in
Section 2, you cannot
select these options.
Required to be
completed if
applicable.
Form continues on next page.
1.814424.115 Page 4 of 5 012371204
5. Signature(s) and Date(s) Form cannot be processed without signature(s) and date(s).
ALL businesses and entities must also complete Section 6.
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC and National Financial Services LLC and their affiliates,
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 direct Fidelity to withdraw
your earnings from the account indicated
in Section 1 in this form and to carry such
amounts pending distribution in accordance
with the terms hereof and to distribute such
amounts according to your instructions set
forth above.
• 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.
If a check issued to you in connection with
your Earnings Automatic Withdrawal Plan
remains uncashed and outstanding for at
least six months:
• Authorize and instruct Fidelity to cancel the
check and return the underlying proceeds
to you by depositing the proceeds into
your account’s core position.
Customers requesting EFT:
• Authorize and request Fidelity to make
EFT distributions of your earnings from the
Fidelity account listed in this form by initiat-
ing 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 nei-
ther 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 trans-
actions. 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 3 is
owned by a natural person, (ii) that person
has authorized his/her account to be cred-
ited 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”) docu-
ment, 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 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.
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.
1.814424.115 Page 5 of 5 012371205
Did you sign the form? Send the ENTIRE form and any attachments
to Fidelity Investments. You will receive a Revised Account Profile
confirming your distribution instructions.
Questions? Go to Fidelity.com/autowithd or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0035
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 439091.13.0 (06/20)
PRINT ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
ADDITIONAL OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
6. Business/Entity Account Certification All businesses and entities must review this section.
If there is only one officer, that officer must sign in Section 5. If there is more than one officer, an authorized
individual other than those signing in Section 5 must also sign below in this Section 6.
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.
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
5. 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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Earnings Automatic Withdrawal Plan Nonret (Fidelity Investments)

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Completed 19 July 2020

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