Fill - Free fillable Electronic Funds Transfer And Bank Wire (Fidelity Investments) PDF form

Questions? Go to Fidelity.com/eft or call 800-343-3548.

Electronic Funds Transfer (EFT) Authorization

Use this form to establish standing Electronic Funds Transfer (EFT) instructions on your Fidelity account, including eligible retirement

and nonretirement accounts. Do NOT use this form to request a specific transaction. 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

• EFT can be used to make routine transfers to or from

your bank, and 3rd Party EFT can be used to make

routine transfers to someone else’s bank. Note: 3rd Party

EFT may not be used to make transfers for commercial

purposes.

• EFT and 3rd Party EFT may not be available during the

first four to five days after the feature is established on

your account.

• Any transaction in your Fidelity IRA initiated with the

instructions you create will result in a distribution from your

Fidelity IRA and will be reported to the IRS. Note that:

– Such distribution will generally result in taxable

income to you for the year distributed to you, unless

it is rolled over to another IRA or qualified employer

plan within 60 days. It is your responsibility to ensure

that the subsequent account is qualified to accept

rollover amounts.

• EFT and 3rd Party EFT are not available for:

– Self-Employed 401(k)

– Workplace Self-Directed Brokerage

– Fidelity Retirement Plan (Keogh)

– Investment-Only Retirement Accounts

• 3rd Party EFT is also not available for:

– Mutual Fund Only Accounts

– Health Savings Accounts (HSAs)

– Business Accounts

• For SIMPLE IRAs, ONLY 3rd Party EFT is available.

• Transaction limits may apply.

• There is no fee to use the EFT service, although your

financial institution may charge transaction fees.

• See “Important Information about Electronic Funds

Transfer (EFT)” included with this form.

1. Account Owner(s)

Name

Additional Owner/Authorized Individual Name

2. EFT Authorization for Your Bank Account

You must be an owner of the account at the other financial institution. This option allows you to transfer money both to

and from your Fidelity account(s). You will need to attach a voided check, deposit slip, or bank statement with the account

number and all owner names preprinted on it.

Provide your Fidelity account number(s) for establishing EFT:

Fidelity Account Number Fidelity Account Number Fidelity Account Number

Provide bank account information below to set up the EFT feature.

Bank Account

Checking Savings

Owner(s) Name(s) Exactly as on Bank Account

Bank Routing /ABA Number Bank Name

Checking or Savings Account Number

Be sure each

account listed is

eligible for EFT.

Complete this section

and attach an account

statement, voided

check, or deposit slip.

1.932149.111 Page 1 of 4 026911001

EFT Authorization for Your Bank Account continues on next page.

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1.932149.111 Page 2 of 4 026911002

3. 3rd Party EFT Authorization For brokerage accounts only.

Complete this section if you are not an owner on the account at the other financial institution. This option ONLY allows you to

move money FROM Fidelity to the outside account.

Provide your Fidelity account number(s) below for establishing 3rd Party EFT:

Fidelity Account Number Fidelity Account Number Fidelity Account Number

Provide bank account information below to set up the 3rd Party EFT feature.

Bank Account

Checking Savings

Owner(s) Name(s) Exactly as on Bank Account

Bank Routing /ABA Number Bank Name

Checking or Savings Account Number

4. W-8-Certified Customers (Non-U.S. Citizens) Explanation for standing instructions

requested for a country different from the country of tax residence.

If you are requesting standing instructions to send money to a financial institution located in a non-U.S. country that is different from the

treaty country listed on your W-8, provide the reason below.

Reason 250 characters maximum

Be sure each

account listed is

eligible for 3rd

Party EFT.

Check ONLY one.

To establish this feature,

you MUST obtain a

Medallion signature

guarantee in Section 5.

Required to be

completed if

applicable.

2. EFT Authorization for Your Bank Account, continued

Attach here:

ABA Transit Routing Number

Account Number

Account number

and all owner

names must be

preprinted and

unaltered.

REQUIRED

Tape your voided check or preprinted deposit slip here.

Form continues on next page.

5. Signature and Date 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 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 Fidelity to act on all instructions

given in this form.

• Accept all terms and conditions described

in this form.

• Certify that all information provided in this

form is true, accurate, and complete.

• Agree, if you are a trustee, a custodian,

or the fiduciary of an employer-sponsored

retirement plan, that you are responsible

for complying with your legal and fiduciary

obligations.

• Authorize us, upon receiving instructions

from you or as otherwise authorized by

you, to make payments from you and to

you or your designee, by credit or debit

entries to the designated account at the

financial institution indicated in the form

(“Bank”). You authorize the Bank to pro-

cess 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 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 Fidelity will not be

liable for any loss, expense, or cost arising

out of your instructions, provided that it

institutes reasonable procedures to pre-

vent unauthorized transactions.

• Acknowledge that you have read and

agree to the Important Information about

Electronic Funds Transfer (EFT) document.

• Understand that Fidelity may purge

unused EFT instructions from your

account(s) on a periodic basis without

notice to you.

• Understand that Fidelity may terminate

the EFT instructions from your account(s)

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 these transactions 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 3rd Party EFT instructions for a bank account that is not in your name.

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

OWNER/AUTHORIZED INDIVIDUAL SIGNATURE

SIGN

DATE MM/DD/YYYY

DATE

PRINT OWNER/AUTHORIZED INDIVIDUAL NAME

MEDALLION SIGNATURE GUARANTEE

OWNER/AUTHORIZED INDIVIDUAL SIGNATURE

SIGN

DATE MM/DD/YYYY

DATE

1.932149.111 Page 3 of 4 026911003

Form 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. 592521.12.0 (05/20)

Did you sign the form and attach a check or any necessary documents?

Send the ENTIRE form and any attachments to Fidelity Investments. You will

receive a “Revised Account Profile” confirming your updates.

Questions? Go to Fidelity.com/eft 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

1.932149.111 Page 4 of 4 026911004

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 these transactions on behalf of the organization.

• State that, 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.

PRINT AUTHORIZED INDIVIDUAL NAME TITLE

AUTHORIZED INDIVIDUAL SIGNATURE DATE MM/DD/YYYY

SIGN

X X

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

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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