Fillable FIDELITY INVESTMENT-ONLY (NON-PROTOTYPE) RETIREMENT ACCOUNT APPLICATION Boston

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FIDELITY INVESTMENT-ONLY (NON-PROTOTYPE) RETIREMENT ACCOUNT APPLICATION Boston

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FIDELITY INVESTMENT-ONLY
(NON-PROTOTYPE) RETIREMENT
ACCOUNT APPLICATION
Complete all relevant sections, sign in ink, and return to Fidelity in the postage-paid envelope or mail to:
Fidelity Investments, P.O. Box 770001, Cincinnati, OH 45277-0036.
IMPORTANT INFORMATION
Please read the important information on the next page before completing this application.
1
ACCOUNT SETUP
Please complete the information as it should appear on your account. All fields in bold are required for
opening an account.
Note: The application cannot be used to open a participant-directed pooled account; you may, however,
use this application to set up a trustee-directed pooled account or “For the Benefit Of” (FBO) accounts for
underlying plan participants, as needed. You must complete an application for each FBO account.
2
FINANCIAL PROFILE
We are required by the Financial Industry Regulatory Authority (FINRA) and other industry regulators to
obtain the information in this section.
3
FUNDING YOUR ACCOUNT
You may pay by check or by transferring assets (from your bank or another account). Simply check the
appropriate box(es) to fund your account.
4
ACCOUNT FEATURES
Your account has a wide range of features to help you manage your plan. More information on each of
these services is included in this section.
5
SIGNATURE
Please be sure to sign your application in ink. We cannot process your application without your signature.
QUESTIONS?
For more information
1-800-FIDELITY or Fidelity.com
(1-800-343-3548)
Print
Reset
Save
Important information
Please read the following before completing this application.
If you do not have an existing Fidelity Non-Prototype Retirement Account, you must attach
copies of the pages of your plan document trust agreement, and/or adoption agreement, as
applicable, that contain the following:
Full trust name
Identity of trustees
Trustee signatures
Generally, this information can be found on the first and last pages of the trust document.
Fidelity provides only the investment vehicle for non-prototype retirement plans and does
not provide any trustee, recordkeeping, tax withholding, or tax reporting services.
Your plan must be a qualified plan under Section 401(a) of the Internal Revenue Code. Plans
that are qualified under Section 401(a) include defined contribution plans [such as 401(k)s, money
purchase, profit sharing] and defined benefit plans. Plans that are not qualified under 401(a) include,
but are not limited to, 403(b) plans and IRAs.
Your account investment activity must be fully disclosed to Fidelity to ensure protection of
our mutual fund shareholders. Therefore, you may not use this application to establish a
participant-directed pooled account for your plan. Fidelity defines a participant-directed pooled
account as follows: A pooled account is a single account that pools the holdings of more than one
participant (or beneficial owner) whose identity is not disclosed to Fidelity and who has the ability
to effect transactions,* and for which subaccounting is performed by the pooled account owner or
a third party.
This application can be used to open either a trustee-directed pooled account or a “For the
Benefit Of” (FBO) account to benefit one participant.
Option A: For a trustee-directed pooled account, all investments are owned at the plan level and all
investment activity is directed by the trustee(s). The underlying participants do not have the ability
to effect transactions* and subaccounting is not performed at the participant level by the account
holder/trustee or a third party.
Most defined benefit plans are trustee-directed pooled accounts.
Option B: For individual FBO accounts, assets for each participant are held in separate accounts.
To open an account for more than one participant, complete one application per participant.
*Ability to “effect transactions” is defined as a participant’s ability to effect any transaction, including — but not limited to — directing a payroll
contribution, requesting an exchange, a loan, a withdrawal (including a hardship withdrawal), a transfer, redemption, and auto-rebalancing, as well as the
ability to direct investment activity and ability to trade in the account.
1.800951.118 006840901
Fidelity Non-Prototype Retirement Account Application p. 1 of 8
1
ACCOUNT SETUP
PLAN INFORMATION
Check here if you have an existing Non-Prototype Retirement Account with Fidelity and you are adding a
participant to your plan. If you checked this box, you are not required to include plan documentation as
requested on the opposite page.
Sponsoring Company Name
Plan Name [e.g., ABC Company 401(k) Plan]
Plan’s Permanent Address
(no P.O. boxes)
Street City State ZIP
Mailing address
(if different from above)
Street City State ZIP
State/Country of organization
Date Plan Established Plan Tax Identification Number
(mm/dd/yyyy)
Plan Structure (Choose Either Option A or Option B)
Option A: This is a trustee-directed pooled account in which all investments are owned at the plan level and all investment
choices are made by the trustee. The underlying participants do not have the ability to effect transactions and subaccounting is
not performed at the participant level by the account holder/trustee or a third party. Ability to “effect transactions” is defined
as a participant’s ability to effect any transaction, including — but not limited to — directing a payroll contribution, requesting
an exchange, a loan, a withdrawal (including a hardship withdrawal), a transfer, a redemption, and auto-rebalancing, as well
as the ability to direct investment activity and ability to trade in the account.
Most defined benefit plans are trustee-directed pooled accounts.
Option B: This is an account for one participant (also known as “For the Benefit Of” [FBO] account). For individual FBO
accounts, assets for each participant are held in separate accounts. Please provide the participant’s information below:
Name of Participant
First Name Middle Name Last Name Social Security Number
Type of Plan (check one box that describes your company’s retirement plan)
401(k) [401k] Profit Sharing [PS] Money Purchase [MP] Defined Benefit/Pension Plan [DEFB]
Other Qualified Plan [QP]
List all plan trustee(s). If more than two trustees, please attach a separate piece of paper with their names and
required information from the trustee section in Account Setup. You must, however, include the signature of each trustee on
this application. (If necessary, utilize the space beneath the “For Fidelity Use Only” box on page 7 to include additional signa-
tures.) The first trustee listed below will receive all account correspondence at the plan’s address provided on the previous page.
PLAN TRUSTEE 1
Full legal name
First Name Middle Name Last Name
Email address Date of birth (mm/dd/yyyy)
1
ACCOUNT SETUP
(CONTINUED)
Social Security number or Taxpayer ID number
Permanent address
(no P.O. boxes)
Street City State ZIP
Mailing address
(if different from above)
Street City State ZIP
Phone numbers Home Work Ext.
Country of Country of
citizenship
U.S. Other tax residence U.S. Other
Employment status Employed Not employed Retired
Occupation (if retired or not employed, indicate source of income)
Employer’s name
Address City ______________________ State ZIP
ASSOCIATIONS
If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial
Industry Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or
an immediate family member residing in the same household of someone who meets the aforementioned employ-
ment criteria, provide the company’s name and address below. By providing this information and completing this
form, you hereby authorize Fidelity to provide the associated person’s employer with duplicate copies of confirma-
tions and statements, or the transactions data contained therein, for your account(s) and any accounts you choose to
have on a consolidated statement for purposes of their compliance review.
Company Name
Company Address
City State/Province ZIP/Postal Code Country
If you are, or an immediate family/household member is, a director, corporate officer, or 10% shareholder of a publicly held
company, or a control person of a publicly traded company under SEC Rule 144, you must provide the information below.
Company Name Trading Symbol or CUSIP
As a person associated
with a member firm, you
are obligated to receive
consent from that firm.
Fidelity has existing
consent agreements
with many firms for
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If
your firm is not one
of them, Fidelity will
attempt to contact your
firm’s compliance office.
Fidelity Non-Prototype Retirement Account Application p. 2 of 8
1.800951.118 006840902
Citizenship
U.S. citizen
Foreign citizen Information in this box must be completed.
Permanent U.S. resident Non-permanent U.S. resident Nonresident of U.S.
Country of Citizenship Country of Tax Residency
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign national identity document
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government
ID showing number
and photo.
1
ACCOUNT SETUP
(CONTINUED)
PLAN TRUSTEE 2
Full legal name
First Name Middle Name Last Name
Email address Date of birth (mm/dd/yyyy)
Social Security number or Taxpayer ID number
Permanent address
(no P.O. boxes)
Street City State ZIP
Mailing address
(if different from above)
Street City State ZIP
Phone numbers Home Work Ext.
Country of Country of
citizenship
U.S. Other tax residence U.S. Other
Employment status Employed Not employed Retired
Occupation (if retired or not employed, indicate source of income)
Employer’s name
Address City ______________________ State ZIP
ASSOCIATIONS
If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial
Industry Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or
an immediate family member residing in the same household of someone who meets the aforementioned employ-
ment criteria, provide the company’s name and address below. By providing this information and completing this form,
you hereby authorize Fidelity to provide the associated person’s employer with duplicate copies of confirmations and
statements, or the transactions data contained therein, for your account(s) and any accounts you choose to have on a
consolidated statement for purposes of their compliance review.
Company Name
Company Address
City State/Province ZIP/Postal Code Country
If you are, or an immediate family/household member is, a director, corporate officer, or 10% shareholder of a publicly held
company, or a control person of a publicly traded company under SEC Rule 144, you must provide the information below.
Company Name Trading Symbol or CUSIP
As a person associated
with a member firm, you
are obligated to receive
consent from that firm.
Fidelity has existing
consent agreements
with many firms for
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If
your firm is not one
of them, Fidelity will
attempt to contact your
firm’s compliance office.
Fidelity Non-Prototype Retirement Account Application p. 3 of 8
1.800951.118 006840903
Citizenship
U.S. citizen
Foreign citizen Information in this box must be completed.
Permanent U.S. resident Non-permanent U.S. resident Nonresident of U.S.
Country of Citizenship Country of Tax Residency
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign national identity document
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government
ID showing number
and photo.
Be sure to sign this application before returning to Fidelity. Please continue.
Generally, among asset classes, stocks may present more short-term risk and volatility than bonds or short-term instru-
ments, but may provide greater potential return over the long term. Although bonds generally present less short-term risk
and volatility than stocks, bonds do entail interest rate risk (as interest rates rise, bond prices usually fall, and vice versa)
and the risk of default, or the risk that an issuer will be unable to make income or principal payments. Additionally, bonds
and short-term investments entail greater inflation risk, or the risk that the return of an investment will not keep up with
increases in the prices of goods and services, than stocks. Finally, foreign investments, especially those in emerging markets,
involve greater risk and may offer greater potential return than U.S. investments.
2
F I N A N C I A L P R O F I L E ( R E Q U I R E D )
YOUR INVESTMENT OBJECTIVE
You should choose your investments for this account based on your objectives, time frame, and tolerance for market fluctuation.
From short-term liquid investments that seek to preserve capital (accepting the lowest returns in exchange for stability) to
longer-term investments that seek maximum growth (but can tolerate very wide fluctuations in performance), you can choose an
approach that’s best for you. Simply check the box below that most closely matches your investment objective.
FEDERAL TAX
BRACKET
1
≤15%
2
25%
3
≥28%
ESTIMATED LIQUID
NET WORTH
1
Under $15,000
1
$15,000–$50,000
2
$50,001–$100,000
3
$100,001–$500,000
4
Over $500,000
ANNUAL INCOME
(from all sources)
1
Under $20,000
2
$20,000–$50,000
3
$50,001–$100,000
4
Over $100,000
ESTIMATED NET WORTH
(excluding residence)
1
Under $30,000
1
$30,000–$50,000
2
$50,001–$100,000
3
$100,001–$500,000
4
Over $500,000
Check one box in each column that represents your company’s investment profile.
Fidelity Non-Prototype Retirement Account Application p. 4 of 8
Short-Term You seek to preserve your capital and can accept the lowest returns in exchange for price stability.
Conservative You seek to minimize fluctuations in market values by taking an income-oriented approach with some potential for capital appreciation
(minimum required for writing covered call options).
Balanced You seek the potential for capital appreciation and some income and can withstand moderate fluctuations in market value.
Growth You have a preference for growth and can withstand significant fluctuations in market value.
Aggressive Growth You seek aggressive growth and can tolerate wide fluctuations in market values, especially over the short term.
Most Aggressive You seek very aggressive growth and can tolerate very wide fluctuations in market values, especially over the short term (required for
options strategies other than writing covered call options).
Check one profile. (Determine your profile using the information below.)
100%
6%
10%
40%
35%
15%
49%
5%
25%
21%
60%
15%
25%
70%
30%
30%
50%
14%
Asset Class
Short-Term
Foreign Stocks
U.S. Domestic Stocks
Bonds
SAMPLE
PORTFOLIO MIX
Lower risk Higher risk
Shorter time frame Longer time frame
Aggressive
Most
1
Short-Term
2
Conservative
6
Balanced
3
Growth
5
Growth
4
Aggressive
1.800951.118 006840904
BY CHECK
I have enclosed a check for $
made payable to Fidelity Investments, to be deposited to
my core Fidelity Account.
TRANSFER FROM OTHER FIRM
I am transferring money or securities from another firm
and have included a Transfer of Assets form
(complete the enclosed form).
BY WIRE
I am wiring funds to Fidelity from my bank or brokerage firm.
(Contact a Fidelity Representative for further instructions.)
TRANSFER FROM EXISTING FIDELITY
NON-PROTOTYPE RETIREMENT ACCOUNT
I am transferring all shares or positions from my Fidelity
Mutual Fund Non-Prototype Retirement Account to my
Fidelity Brokerage Non-Prototype Retirement Account.
My account number is:
–
3
F U N D I N G Y O U R A C C O U N T
The minimum initial deposit required to open this account is generally $500 in cash and/or eligible securities. You
may fund your Fidelity Account in any of the four ways listed below:
PURCHASE FUNDS
Please purchase a mutual fund(s) as indicated below. I understand the fund(s) can only be purchased consistent with its prospectus at the
next available share price on the day of deposit of my retirement money to my core account. I have read the prospectus for this fund. If no
selection is made, I understand that deposits will be invested in the core account, which is the Fidelity Government Money Market Fund.
Fund Family Fund Name
Fund Symbol Amount $
Fund Family
Fund Name
Fund Symbol Amount $
Fidelity Non-Prototype Retirement Account Application p. 5 of 8
4
A C C O U N T F E AT U R E S
You may select additional features for this account.
RECEIVE ACCOUNT DOCUMENTS ONLINE
For your convenience, certain account documents can be delivered to you electronically. These include account statements, trade
confirmations, prospectuses, and shareholder reports. In addition, as other documents become available, we will be able to deliver
them to you electronically instead of by U.S. mail.
If you do not want electronic delivery of your account documents, you should check off one or more of the boxes below. In
order to enroll in the electronic delivery program and begin receiving account documents electronically, you will need to read the
Electronic Delivery Agreement and consent to its terms. You will receive the Electronic Delivery Agreement in an email, unless you
select all of the options below.
I would prefer to receive the following documents by U.S. mail:
Monthly Account Statements
Trade Confirmations and Related Prospectuses
Prospectuses, Shareholder Reports, and Other Documents
1.800951.118 006840905
Fidelity Non-Prototype Retirement Account Application p. 6 of 8
4
A C C O U N T F E AT U R E S
(CONTINUED)
DUPLICATE STATEMENTS AND CONFIRMS
Activity in this account will be reported on a statement and automatically sent to the first trustee at the plan address. If you,
the trustee, would like a participant or other party to be named as an interested party to receive duplicate statements and
confirmations for this account, provide the information below.
Interested Party Name
Name
Street City State ZIP
CHECKWRITING
1
This service allows you to write checks on the cash in your core account. Please sign and attach the Fidelity Checkwriting Form.
MARGIN CREDIT
2
Check this box if your plan allows margin and you would like this account to be considered for this feature. In addition to
risks generally applicable to margin borrowing, utilizing margin within a tax-advantaged retirement account poses additional
risks, including 1) using account assets to satisfy margin calls reduces tax-advantaged savings, 2) annual contribution limits
may restrict a plan trustee’s ability to satisfy margin calls, and 3) debt-financed investment income within a tax-advantaged
account can generate unrelated business taxable income (UBTI). You are strongly encouraged to consult your tax or benefits
advisor prior to utilizing margin borrowing on this account.
5
S I G N AT U R E
(ALL OWNERS MUST SIGN THE APPLICATION)
LIMITED TRADING AUTHORITY
As trustee, it is your responsibility to ensure that all account transaction and investment instructions provided are in accor-
dance with the underlying plan and trust. This feature gives the plan participant or other third party the right to inquire,
trade, buy, sell, and exchange (but not make cash withdrawals) within the account without the involvement of the trustee.
Note: If you do authorize plan participants to make exchanges, you will not be able to limit the investment choices your employees
can access. To add this feature, you must complete and submit a Fidelity Trading Authority Form.
On behalf of the Trust, I hereby request Fidelity Brokerage Services LLC and National Financial Services LLC (collectively,
“Fidelity” or “you”) to open a Fidelity Brokerage Non-Prototype Retirement Account in the name of the plan listed as
account owner on this application. The Trustee(s) of such plan hereby certifies the following:
• Fidelity has the authority to accept orders and other instructions relative to the Trust accounts identified herein from those
individuals or entities listed in Section 1. They may execute any documents on behalf of the Trust which you may require.
By signing this form, the Trustee(s) hereby certifies(y) that you are authorized to follow the instructions of any Trustee and to
deliver funds, securities, or any other assets in the brokerage account to any Trustee or on any Trustee’s instructions, including
delivering assets to a Trustee personally. Fidelity, in its sole discretion and for its sole protection, may require the written consent
of any or all Trustees prior to acting upon the instructions of any Trustee.
• There are no Trustee(s) of the Trust other than those listed in Section 1 or identified on a separate piece of paper attached to this
application. The attached pages of the Trust document are true copies of the valid legal plan document currently in effect.
• Should only one person execute this agreement, it shall be a representation that the signer is the sole Trustee. Where applicable,
plural references in this certification shall be deemed singular.
• We, the Trustees, assume all fiduciary responsibility as Trustee(s) of the plan assets, as well as administrative responsibility for all
applicable recordkeeping, tax reporting, and tax withholding requirements.
• We, the Trustees, have obtained, and will maintain, a plan and Trust agreement qualified under Section 401(a) of the Internal
Revenue Code.
• We, the Trustees, have the power under the Trust and applicable law to enter into the transactions and issue the instructions that
we make in this account. Such power may include, without limitation, the authority to buy, sell (including short sales), exchange,
convert, tender, redeem, and withdraw assets (including delivery of securities to and from the account) or otherwise (including
the sale or purchase of option contracts) for and at the risk of the Trust. We understand that all orders and transactions will be
governed by the terms and conditions of all other account agreements applicable to this account.
1
All checks written will be reported on your account statement. Fidelity must have the signed form on file to establish this service.
2
Subject to Fidelity’s approval. May require a review of your credit history. Margin borrowing involves additional risks and is not suitable for all investors. By checking the box and signing this
application, you acknowledge that you have read the margin agreement section of the Fidelity Brokerage Non-Prototype Retirement Account Customer Agreement and agree to its terms.
1.800951.118 006840906
1.800951.118 006840907
Fidelity Non-Prototype Retirement Account Application p. 7 of 8
5
S I G N AT U R E
(ALL OWNERS MUST SIGN THE APPLICATION)
( C O N T I N U E D )
• We, the Trustees, jointly and severally, indemnify you and hold you harmless from any claim, loss, expense, or other liability
for effecting any transactions (including distributions) and acting upon any instructions given by the Trustees. We, the Trustees,
certify that any and all transactions effected and instructions given on this account will be in full compliance with the plan and
Trust, as with the Employee Retirement Income Security Act of 1974, as amended, and the Internal Revenue Code.
• We, the Trustees, agree to inform you in writing of any change in the composition of the Trustees, or any other event that could
alter the certifications made above.
• We, the Trustees, agree that any information we give to Fidelity on this account will be subject to verification, and we authorize
you to obtain a credit report about any or all of the Trustees at any time. Upon written request, Fidelity will provide the name
and address of the credit reporting agency used.
• We, the Trustees, represent and warrant that, if we have not completed the section titled Associations, we are not associated
with or employed by a stock exchange or a broker-dealer and that we are not a control person or associate of a public company
under SEC Rule 144 (such as a director, 10% shareholder, or a policymaking officer), or an immediate family or household
member of such a person.
We acknowledge that we have read, understood, and agree to the terms and conditions set forth in the Fidelity Brokerage Non-
Prototype Retirement Account Customer Agreement, hereinafter referred to as “Customer Agreement,” as are currently in effect
and as may be amended from time to time.
We acknowledge that we have received the description of the Core Account in the Customer Agreement, including
Fidelity’s right to change the options available as core positions, and consent to having free credit balances held or
invested in the core position indicated above.
We certify that all Trustees are at least 18 years of age and of full legal age in the state in which they reside. We understand that
upon issuers’ request in accordance with applicable rules and regulations, that you will disclose our names to issuers of any securi-
ties held in the account so we can receive important information, unless we notify you in writing not to do so. We understand that
it is our responsibility to read the prospectus for any mutual fund we purchase or into which we exchange.
The application shall be construed, administered and enforced according to the laws of the Commonwealth of Massachusetts,
except as superseded by federal law or statute. The Fidelity Brokerage Non-Prototype Retirement Account Customer Agreement
shall inure to the benefit of Fidelity’s successors and assigns, whether by merger, consolidation or otherwise.
We certify that all information provided in this application is true, accurate, and complete.
We certify under penalties of perjury that (1) the Social Security or taxpayer identification numbers provided above are correct.
We hereby authorize Fidelity to hypothecate (lend) or rehypothecate, either separately or with the property of others,
either to Fidelity or to others, any property in our account. This authorization shall remain in force until Fidelity receives
written notice of revocation.
We have received and read either the Prospectus or the Profile Prospectus for Fidelity Government Money Market Fund. If
we received the profile prospectus, we understand that we may purchase shares of Fidelity Government Money Market Fund
now or request to receive and review the fund’s full prospectus before we make a decision to invest in Fidelity Government
Money Market Fund. If we choose to invest now, we understand that Fidelity Government Money Market Fund will serve as
the money market fund used to hold assets of our Non-Prototype Retirement Account pending other investment instructions.
We understand that we could lose money by investing in a money market fund. Although the fund seeks to preserve the
value of our investment at $1.00 per share, it cannot guarantee it will do so. An investment in the fund is not insured or
guaranteed by the Federal Deposit Insurance Corporation or any other government agency. Fidelity Investments and its
affiliates, the fund’s sponsor, have no legal obligation to provide financial support to money market funds, and we should not
expect that the sponsor will provide financial support to the fund at any time.
• We understand that Fidelity’s government and U.S. Treasury money market funds will not impose a fee upon the sale of our shares,
nor temporarily suspend our ability to sell shares if the fund’s weekly liquid assets fall below 30% of its total assets because of
market conditions or other factors.
1.800951.118 006840908
X
SIGNATURE OF PLAN TRUSTEE 1 Date (mm/dd/yyyy)
X
SIGNATURE OF PLAN TRUSTEE 2 Date (mm/dd/yyyy)
Fidelity Investments is a registered service mark owned by FMR LLC. Accounts are carried with our affiliate, National Financial Services LLC,
Member NYSE, SIPC. Fidelity Investments, P.O. Box 770001, Cincinnati, OH 45277-0036.
441124.12.0 Fidelity Brokerage Services LLC, Member NYSE, SIPC NP-BKAPP-0818
To help the government fight financial crimes, Federal regulation requires Fidelity to obtain your name, date of birth, address,
and a government-issued ID number before opening your account, and to verify the information. In certain circumstances,
Fidelity may obtain and verify comparable information for any person authorized to make transactions in an account. Also,
Federal regulation requires Fidelity to obtain and verify the beneficial owners and control persons of legal entity customers.
Requiring the disclosure of key individuals who own or control a legal entity helps law enforcement investigate and prosecute
crimes. Your account may be restricted or closed if Fidelity cannot obtain and verify this information. Fidelity will not be
responsible for any losses or damages (including, but not limited to, lost opportunities) that may result if your account is
restricted or closed.
The account established with this application is governed by a predispute arbitration clause, which is located on the last
page of the Customer Agreement. We acknowledge receipt of the predispute arbitration clause.
Fidelity Non-Prototype Retirement Account Application p. 8 of 8
5
S I G N AT U R E
(ALL OWNERS MUST SIGN THE APPLICATION)
( C O N T I N U E D )
Page 1 of 2
Questions? Go to Fidelity.com/trustedcontact or call 800-343-3548.
Trusted Contact Authorization Form
Your physical and financial well-being are among our top priorities. Let us help you safeguard both.
Use this form to designate a primary and alternate trusted contact, that is 18 years or older, for your Fidelity account(s). Do NOT use
this form for charitable giving accounts or workplace retirement plans, such as a 401(k). 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 prepare yourself and your trusted contact(s) for success,
consider choosing someone with whom you are comfortable
discussing your health, relationships, loved ones, work,
and finances. You may also want to consider selecting
someone who isn’t currently involved in your financial life,
like a beneficiary or power of attorney, to ensure fairness
and objectivity.
• This form supersedes any previous trusted contact
designations that you may have submitted.
• If you are using this form for an Entity relationship (for ex: a
business account), we will assign the Trusted Contact(s) to the
Authorized Individual that signs this form.
• If Fidelity has questions or concerns about your health or welfare
due to potential diminished capacity, financial exploitation or
abuse, endangerment, and/or neglect, this form authorizes us to
get in touch with the trusted contact(s) and:
– Provide the trusted contact(s) listed below with information
about you and/or your account(s), including notice of a
temporary hold, but does not provide him or her with the
ability to transact on your account(s).
– Inquire about your current contact information or
health status.
– Inquire about whether another person or entity has legal
authority to act on your behalf (e.g., legal guardian or
conservator, executor, or trustee).
1. Account Owner
First Name Middle Name Last Name
Social Security or Taxpayer ID Number
2. Accounts Included
ALL eligible accounts associated with the above Social Security or Taxpayer ID Number
Skip to Section 3.
ONLY the account(s) listed below:
Fidelity Account Number Fidelity Account Number Fidelity Account Number
Fidelity Account Number Fidelity Account Number Fidelity Account Number
3. Primary Trusted Contact
First Name Middle Name Last Name
Email
Phone Extension
Check here if phone number is a mobile number.
Relationship to Owner
Check only one.
The trusted contact
should be someone
other than the individ-
ual listed in Section 1.
1.9883825.101 037430101
Primary Trusted Contact continues on next page.
Page 2 of 21.9883825.101 037430102
Legal/Permanent Address
Street Address
City State/Province ZIP/Postal Code Country
4. Alternate Trusted Contact
First Name Middle Name Last Name
Email
Phone Extension
Check here if phone number is a mobile number.
Relationship to Owner
Legal/Permanent Address
Street Address
City State/Province ZIP/Postal Code Country
5. Signature and Date Form cannot be processed without your signature and date.
By signing below, you:
• Authorize Fidelity to communicate with
your trusted contact(s) and disclose
information about designated accounts
to address possible financial exploitation
or confirm specifics about your current
contact information, your health status, or
the identity of any legal guardian, executor,
trustee, or holder of a power of attorney, or
as otherwise permitted.
• Understand that this does not authorize
your trusted contact(s) to separately access
or transact on your account(s).
• Understand that you may identify multiple
trusted contacts on this form, provided
they are 18 years or older.
• Understand that this trusted contact
designation is optional and you may
withdraw it at any time by notifying Fidelity
in writing to one of the business addresses
listed below.
• Understand that you may change
your trusted contact(s) at any time by
completing a new form.
• Certify that all information you provided is
correct to the best of your knowledge.
• Acknowledge that we may remove any
trusted contact from any account, at any
time or for any reason.
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE DATE MM/DD/YYYY
SIGN
X X
This cannot be a
PO box, mail drop,
or c/o.
The trusted contact
should be someone
other than the individ-
ual listed in Section 1.
This cannot be a
PO box, mail drop,
or c/o.
3. Primary Trusted Contact, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 802990.2.0 (12/18)
Did you sign the form? Send the ENTIRE form to Fidelity.
Questions? Go to Fidelity.com/trustedcontact 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
Use the postage-paid envelope, drop off at a Fidelity
Investor Center, OR deliver to:
Page 1 of 6
Questions? Go to Fidelity.com/accountauthority or call 800-343-3548.
1.926568.112 017291301
Account Authority
Use this form to grant a third party some or all of the powers over your account(s) as described below, or to provide updated
information about a third party who already holds authority over your account(s). Do NOT use this form for fiduciary accounts,
workplace retirement plans, such as a 401(k), or to add an individual who will be paid for the investment management of the
account(s). 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
• On this form, “Fidelity,” “us,” and “we” include Fidelity
Brokerage Services LLC, Fidelity Distributors Corporation,
National Financial Services LLC, Fidelity Personal and
Wealth Advisors LLC, and their affiliates, employees,
agents, and representatives as the context may require.
• Unless indicated otherwise in this form, “you,” “your,”
and “account owner” refer to the registered owner(s) of
the account; and for any account with more than one
owner (such as a joint or trust account), “you,” “your,”
and “account owner” or “account owners” refer to all
owners, collectively and individually.
• Fill out a separate form for each authorized agent.
• You don’t need to complete this form for an owner — all
account owners already have authority.
• This form cannot be used to add an individual who
will be paid for the investment management of the
account(s). To establish a Registered Investment Advisor
relationship, please contact Fidelity Institutional Wealth
Services at 800-735-3756.
• For any account listed on this form that is currently
approved for options trading, you must submit a new
Options Application.
• For Fidelity Retirement Plan (Keogh) Accounts, the plan
administrator must sign.
• For Investment-Only Retirement accounts (also known
as Non-Prototype Retirement accounts), the plan trustee
can grant the plan administrator Full Authority. Plan
participants can only be granted Limited Authority.
Other individuals can be granted Limited Authority with
approval of the plan trustee.
• For an ABLE account, only a Designated Beneficiary/
Eligible Beneficiary can grant Limited or Full Authority
on an account that does NOT already have a Person with
Signature Authority (PSA) relationship established. This
form should not be completed for an ABLE account that
has a PSA established.
• For annuities, you can only use this form to grant
Limited Authority.
• A Medallion signature guarantee is required to add
Full Authority. If the Medallion signature guarantee
is not provided, Limited Authority will be added to
the account.
1. Account Owner(s)
Name
Name
2. Account(s) Included
Account Number Account Number Account Number
Account Number Account Number Account Number
Enter full name as
evidenced by a
government-issued,
unexpired document
(e.g., driver’s license,
passport, permanent
resident card).
Form continues on next page.
Print
Reset
Reset
Print
Reset
Page 2 of 61.926568.112 017291302
3. Authority Choices Choose only one level of authority.
Limited Authority
Grant LIMITED Authority to the agent named in this form with respect to each account identified in Section 2.
Default if no choice indicated.
All eligible registration types (except 529 College
Savings Plans, ABLE Accounts, and Fidelity
managed accounts)
Gives agent authority to:
• view your account online
• access your tax forms
• buy and sell securities in your account
• trade or exercise options in your account, to the extent
your account is approved for options
• incur margin debt, if your account is approved for margin
• deposit a check into your account
529 College Savings Plan Accounts
Gives agent authority to:
• view your account online
• access your tax forms
• exchange previously invested money among portfolios
twice per calendar year
• change your future allocation instructions
• deposit a check into your account
Fidelity managed accounts
Gives agent authority to:
• view your account online
• access your tax forms
• update your individual financial situation, investment
objectives, risk tolerance, planned investment time
horizon, certain federal income tax considerations,
investment restrictions, and other information captured
in the Investor Profile Questionnaire (IPQ)
• deposit a check into your account
ABLE Accounts
Gives agent authority to:
• view your account online
• access your tax forms
• exchange previously invested money among
portfolios twice per calendar year
• change your future allocation instructions
• deposit a check into your account
Full Authority
NOT available for Annuities, BrokerageLink, Roth IRA for Kids, and UGMA/UTMA accounts.
Grant FULL Authority to the agent named in this form with respect to each account identified in Section 2.
All eligible registration types (except 529 College
Savings Plans, ABLE Accounts, and Fidelity
managed accounts)
Gives agent all powers of Limited Authority listed
above, plus gives authority to:
• initiate IRA rollovers, recharacterizations, and Roth
IRA conversions
• make federal, state, local, or foreign tax elections
• remove cash from the account, either by sending a
check to the address of record or by transferring cash to
a bank account pre-authorized by the account owner(s)
• transfer cash or assets among other Fidelity accounts
held by the same owner(s)
529 College Savings Plan Accounts
Gives agent all powers of Limited Authority for
529 plans, plus authority to:
• remove cash from the account by either sending
a check to the registered owner at the address
of record or to a college or university if Standing
Payment Instructions are already on file, or by trans-
ferring cash to a bank account pre-authorized by the
account owner(s)
Fidelity managed accounts
Gives agent all powers of Limited Authority listed above,
plus gives authority to:
• initiate IRA rollovers, recharacterizations, and Roth IRA
conversions
• make federal, state, local, or foreign tax elections
• remove cash from the account, either by sending a
check to the address of record or by transferring cash
to a bank account pre-authorized by the account
owner(s)
• transfer cash or assets among other Fidelity accounts
held by the same owner(s)
ABLE Accounts
Gives agent all powers of Limited Authority for ABLE
Accounts, plus authority to:
• remove cash from the account by either sending a
check to the registered owner at the address of record
or to a third party if Standing Payment Instructions are
already on file
4. Existing Authorized Agents
Keep any existing authorized agents in place Default if no choice indicated.
Remove all existing authorized agents.
Remove only the following authorized agent:
Name
Granting FULL
Authority requires a
Medallion signature
guarantee in
Section 7.
Check no more
than one.
Form continues on next page.
Page 3 of 61.926568.112 017291303
5. Add an Authorized Agent Cannot be a minor. Sections 5 and 6 must be completed by the authorized agent.
The authorized agent should complete this section. Account owners already have Full Authority over their account(s). Note: Authorized agents
who are being paid for their investment management of the account(s) are not permitted.
First Name Middle Name Last Name
Date of Birth MM DD YYYY Social Security or Taxpayer ID Number Relationship to Owner
Authorized Agent Initials
Initial here to confirm that you will not be paid
for the investment management of the account(s).
Legal / Residential Address (where you live) This is the legal address used for tax reporting.
Address
City State/Province ZIP/Postal Code Country
Mailing Address This may be a PO box, drop box, or c/o location.
Same as legal / residential address
Default if no other information indicated below.
Address
City State/Province ZIP/Postal Code Country
Citizenship
U.S. citizen
Foreign citizen Information in this box must be completed.
Permanent U.S. resident Nonpermanent U.S. resident Nonresident of U.S.
Country of Citizenship Country of Tax Residency Only applicable to nonresidents of the U.S.
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign National Identity Document
Income Source Industry regulations require us to ask for this information.
Employed Self-employed
Occupation Employer Leave blank if self-employed.
Employer Address
City State/Province ZIP/Postal Code Country
Retired Not employed
Source of Income Pension, investments, spouse, etc.
Enter full name as evidenced
by a government-issued,
unexpired document (e.g.,
driver’s license, passport, per-
manent resident card).
Required
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government ID
showing number and photo.
Check one and
provide information.
Add an Authorized Agent continues on next page.
Page 4 of 61.926568.112 017291304
Associations
If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial
Industry Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or
an immediate family member residing in the same household of someone who meets the aforementioned employ-
ment criteria, provide the company’s name and address below. By providing this information and completing this form,
you hereby authorize Fidelity to provide the associated person’s employer with duplicate copies of confirmations and
statements, or the transactions data contained therein, for your account(s) and any accounts you choose to have on a
consolidated statement for purposes of their compliance review.
Company Name
Company Address
City State/Province ZIP/Postal Code Country
If you are, or an immediate family/household member is, a director, corporate officer, or 10% shareholder of a publicly held
company, or a control person of a publicly traded company under SEC Rule 144, you must provide the information below.
Company Name Trading Symbol or CUSIP
Duplicate Materials If the authorized agent works for a member firm, additional copies will be sent to that firm as well as to the agent.
Send account statements to the authorized agent
Send trade confirmations to the authorized agent
6. Authorized Agent Signature and Date Named authorized agent must sign and date.
By signing below, you (in this Section 6, “you” and “your” refer to the authorized agent):
• Affirm that you are at least 18 years old and
of full legal age to enter into the agree-
ments in your state of residence.
• Acknowledge that you have received a
copy of this form and the Account Authority
Agreement, and you state that you have
read them, you understand them, and you
accept all their terms and conditions. (This
does not apply to annuities.)
• Agree to be bound by the current and
future terms of all agreements, and by any
applicable disclosures, between the account
owner(s) and Fidelity.
• Represent and warrant that if you have not
completed the section titled Associations,
you are not associated with or employed by
a stock exchange or a broker-dealer, and that
you are not a control person or associate of
a public company under SEC Rule 144 (such
as a director, a 10% shareholder, or a policy-
making officer), or an immediate family or
household member of such a person.
• State that you are familiar with and
understand the investment objectives of
the account owner(s) and will use only trading
strategies that are consistent with these
objectives and the level of authority indicated.
• For accounts managed by a registered
investment advisor, state that you are
familiar with and understand the investment
objectives of the advisor(s) and will use only
trading strategies that are consistent with
these objectives.
• Certify that all information you provided in
this form is true, accurate, and complete.
• Grant us permission to obtain credit
information, verify information you have
provided, and perform a background check
on you.
• Acknowledge that we may refuse to approve
you as authorized agent, or may remove you
as authorized agent from this or any other
account, at any time and for any reason.
• Agree to act in compliance with all applicable
laws and regulations.
• Acknowledge that entities and individuals
who provide investment advice to others
may be subject to regulation by federal and
state regulators and agree to be responsible
for determining whether and what type of
registration is required.
• Certify that you will not be paid for the
investment management related to the
account(s). If you are looking to establish a
Registered Investment Advisor relationship,
please contact Fidelity Institutional
Wealth Services.
For Fidelity Retirement Plan (Keogh) Accounts,
if the current Plan Administrator is being added
as the authorized agent:
• State that you are also the Plan Administrator
or Employer responsible for the Plan for
which authority is being requested on
this form.
• Consent to the appointment as the
authorized agent identified in this form,
understanding that:
– As the authorized agent, you will be
granted either Limited or Full Authority, as
indicated in Section 3 and as described in
the Account Authority Agreement, and will
be authorized only to place orders that are
permitted by the Plan.
– As the authorized agent, you are not autho-
rized to designate a beneficiary or establish
a new Plan.
– Fidelity Management Trust Company acts
only as custodian or trustee for this Plan,
and has no discretionary fiduciary authority
or responsibility; the account owner, there-
fore, is solely responsible for determining
the suitability of, and for accepting all con-
sequences of, all investments and actions
taken on the account(s).
As a person associated
with a member firm, you
are obligated to receive
consent from that firm.
Fidelity has existing
consent agreements
with many firms for
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If
your firm is not one
of them, Fidelity will
attempt to contact your
firm’s compliance office.
Check any that apply.
5. Add an Authorized Agent, continued
Authorized Agent Signature and Date continues on next page.
Page 5 of 61.926568.112 017291305
To help the government fight financial crimes, federal regulation requires Fidelity to obtain and verify your name, date of birth, address, and a
government-issued ID number before opening your account, and to verify the information. In certain circumstances, Fidelity may obtain and
verify comparable information for any person authorized to make transactions in an account. Also, federal regulation requires Fidelity to obtain
and verify the beneficial owners and control persons of legal entity customers. Requiring the disclosure of key individuals who own or control
a legal entity helps law enforcement investigate and prosecute crimes. Your account may be restricted or closed if Fidelity cannot obtain and
verify this information. Fidelity will not be responsible for any losses or damages (including, but not limited to, lost opportunities) that may result
if your account is restricted or closed.
PRINT AUTHORIZED AGENT NAME
AUTHORIZED AGENT SIGNATURE DATE MM/DD/YYYY
SIGN
X X
7. Account Owner Signatures and Dates
By signing below, you:
• Acknowledge that you have received a copy
of the Account Authority Agreement, and you
state that you have read it, you understand it,
and you accept all the terms and conditions
of the agreement, including the pre-dispute
arbitration clause, and the terms and condi-
tions described in this form. (This does not
apply to annuities.)
• Authorize Fidelity to act on all instructions
given on this form.
• Designate the individual identified in this
form as your authorized agent, granting that
individual the ability to take action consistent
with the level of authority indicated, and
acknowledge and agree that any and all
disclosures, required or otherwise, may be
provided solely to the individual acting on
your behalf as part of the scope of his or
her authority.
• State, if signing as a trustee, that you
have the power to enter into the sales,
redemptions, and other transactions of mutual
fund shares or municipal fund securities, and
that you agree to execute any documents on
behalf of the trust that we may require.
• Certify that all information you provided in
this form is true, accurate, and complete.
• Acknowledge that we may remove any
authorized agent from this, or any account,
at any time and for any reason.
• Certify that you are not adding an individual
who will be paid for his or her investment
management of the account(s).
For Fidelity Retirement Accounts, if the current
Plan Administrator is also the account owner:
• State that you are also the Plan Administrator
or Employer responsible for the Plan for
which authority is being requested on
this form.
• Consent to the appointment of the
authorized agent identified in this form,
understanding that:
– The authorized agent will be granted either
Limited or Full Authority, as indicated
in Section 3 and as described in the
Account Authority Agreement, and will be
authorized only to place orders that are
permitted by the Plan.
– The authorized agent is not authorized to
designate a beneficiary or establish a
new Plan.
– Fidelity Management Trust Company acts
only as custodian or trustee for this Plan, and
has no discretionary fiduciary authority or
responsibility; therefore you, as the account
owner, are solely responsible for determining
the suitability of, and for accepting all
consequences of, all investments and actions
taken on the account(s).
One owner 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 if you are requesting Full Authority. If the Medallion signature guarantee is not provided,
Limited Authority will be added to the account(s).
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can get
one 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
Account Owner Signatures and Dates continues on next page.
6. Authorized Agent Signature and Date, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 576564.13.0 (05/19)
Did you sign the form and attach any necessary documents?
Send form and any attachments to Fidelity Investments.
Questions? Go to Fidelity.com/accountauthority 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
Use the postage-paid envelope OR deliver to:
Page 6 of 61.926568.112 017291306
PRINT OWNER NAME
MEDALLION SIGNATURE GUARANTEE
OWNER SIGNATURE
SIGN
X
DATE MM/DD/YYYY
DATE
X
8. Plan Administrator / Employer Signature and Date
Required ONLY for Fidelity Retirement Plan (Keogh) Accounts. In this Section 8, “you” refers to the Plan
Administrator or Employer signing below.
By signing below, you:
• State that you are the Plan Administrator or
Employer responsible for the Plan for which
authority is being requested on this form.
• Consent to the appointment of the
authorized agent identified in this form,
understanding that:
– The authorized agent will be granted
either Limited or Full Authority, as indi-
cated in Section 3 and as described in
the Account Authority Agreement, and
will be authorized only to place orders
that are permitted by the Plan.
– The authorized agent is not authorized
to designate a beneficiary or establish a
new Plan.
– Fidelity Management Trust Company acts
only as custodian or trustee for this Plan,
and has no discretionary fiduciary author-
ity or responsibility; the account owner,
therefore, is solely responsible for deter-
mining the suitability of, and for accepting
all consequences of, all investments and
actions taken on the account(s).
PRINT ADMINISTRATOR/EMPLOYER NAME
ADMINISTRATOR/EMPLOYER SIGNATURE DATE MM/DD/YYYY
SIGN
X X
7. Account Owner Signatures and Dates, continued
Questions? Go to Fidelity.com/accountauthority or call 800-343-3548.
Account Authority
Customer Agreement
Purpose
This document describes the terms and conditions associated with
granting certain types of account authority. Please review this doc-
ument and keep it for your records. Do not return it to Fidelity.
Who’s Who in This Agreement
In this document, “Fidelity,” “us,” and “we” include Fidelity
Brokerage Services LLC, Fidelity Distributors Corporation,
National Financial Services LLC, and Fidelity Personal and Wealth
Advisors LLC, as the context may require. “Account owner” refers
to the registered owner(s) of the account or to any new account
applicant; for any account with more than one owner or autho-
rized individual (as distinct from an authorized agent), “account
owner” or “account owners” refers to all owners, collectively and
individually. “Authorized agent” is the individual identified as
such in an Account Authority form. “You” refers to the account
owner(s) and/or the authorized agent, as the context may require.
Terms and Conditions — Account Owner
Fidelity’s Commitments to You
Under this agreement, we have certain rights and responsibilities.
When we accept your Account Authority form, we are agreeing to
accept orders on your account from your designated third party —
the authorized agent — according to the terms described in this
agreement. We also agree to provide, upon written request, the
name and address of any credit reporting agency from whom we
have obtained information pertaining to this account.
Note that we assume no responsibility for reviewing or monitoring
any investment decision or activity of the authorized agent, nor do we
provide any tax, legal, or investment advice or recommendations.
Your Commitments to Fidelity
By signing in the appropriate place on the Account Authority form,
you, the account owner:
• Acknowledge that you have received and read this agreement,
and that you understand and agree to its terms.
• Authorize us to accept instructions from your authorized agent
consistent with the level of trading authority you are granting.
• Accept full responsibility for determining whether any investment
or strategy is appropriate for you, based on your investment
objectives and financial resources.
• Accept full responsibility for understanding the risks associated
with granting authority, and assume sole liability for the financial,
tax, and other consequences of all actions and instructions of the
authorized agent.
• Acknowledge and agree that any and all disclosures, required or
otherwise, may be provided solely to the individual acting on your
behalf as part of the scope of his or her authority.
• Acknowledge that your account will be charged for each trade
that is executed in your account, including trades ordered by an
authorized agent, and you agree to pay these charges.
• Acknowledge that you are not adding an individual who will be
paid for his or her investment management of the account(s).
Limited Authority
For brokerage accounts, Limited Authority allows your authorized
agent to inquire into your account (such as by viewing it online),
and to place orders in your account without direct instructions from
you. This may include orders to buy, sell (including short sales),
exchange, convert, tender, or otherwise acquire or dispose of
securities, such as stocks, bonds, and other investments.
The authorized agent may incur margin debt and may buy, sell, or
exercise options, to the extent that your account is approved for
these activities.
For 529 College Saving Plan accounts and ABLE Plan accounts,
Limited Authority allows your authorized agent to inquire into your
account(s), exchange previously invested money among portfolios
twice per calendar year, and change your future allocation instructions.
For Fidelity managed accounts, Limited Authority allows your
authorized agent to view your account(s) online and to update your
individual financial situation, investment objectives, risk tolerance,
planned investment time horizon, certain federal income tax consid-
erations, investment restrictions, and other information captured in
the Investor Profile Questionnaire (IPQ).
Limited Authority does not allow your authorized agent to remove
money or assets from your account(s).
Full Authority
For brokerage accounts, Full Authority grants your authorized agent
all of the capabilities of Limited Authority as well as the authority to
remove money or assets from your account(s). Any assets removed
must be delivered to you at your address of record or to a bank
account pre-authorized by you.
With Full Authority, the authorized agent may initiate IRA rollovers,
Roth IRA conversions, IRA recharacterizations, or other transfers of
assets between and among your accounts. To the extent permitted
by the applicable taxing authority, the authorized agent may also
exercise any tax election related to your Fidelity accounts that is avail-
able to you under federal, state, local, or foreign tax law.
For 529 College Savings Plan accounts, Full Authority grants your
authorized agent all powers of Limited Authority, plus the right to
remove cash from your account(s) by sending a check to the regis-
tered owner at the address of record or to a college or university if
Check Standing Instructions are already on file, or by transferring cash
to a bank account pre-authorized by the account owner(s).
For ABLE Plan accounts, Full Authority grants your authorized agent
all powers of Limited Authority, plus the right to remove cash from
your account by sending a check to the registered owner at the
address of record or to a third party, if Standing Payment Instructions
are already on file.
For Fidelity managed accounts, Full Authority allows your autho-
rized agent all the powers of Limited Authority plus the ability to
initiate IRA rollovers, recharacterizations, and Roth IRA conversions,
make federal, state, local, or foreign tax elections, remove cash from
account(s), either by sending a check to the address of record or by
transferring cash to a bank account pre-authorized by the account
owner(s), or transfer cash or assets among other Fidelity accounts
held by the same owner(s).
With respect to a Fidelity Retirement Plan (Keogh) Account, or any
type of IRA, neither level of authority permits the authorized agent to
designate beneficiaries or to establish a new IRA or retirement plan.
Multiple Authorized Agents
If you have appointed two or more authorized agents, we will con-
sider each of them to have the power to act alone (severally) and
without the consent of any other authorized agent, with respect to
each power granted above.
Should we receive conflicting or inconsistent instructions from your
authorized agents, we may restrict your account(s) from further activity.
Such a restriction may remain in place until we receive adequate
instructions on how to proceed. These may be in the form of written
instructions signed by all owners or by all authorized agents, or a
court order.
Page 1 of 2
Terms and Conditions — Authorized Agent
Your Commitments to Fidelity
By signing in the appropriate place on the Account Authority form,
you, the authorized agent:
• Acknowledge that you have received and read this agreement,
and that you understand and agree to its terms.
• Agree to be solely responsible to the account owner(s) for all
investment decisions, trading strategies, and instructions placed
on the account.
• Agree to act on the account only as specifically authorized by the
account owner(s) and in compliance with all applicable laws, regu-
lations, and Fidelity policies.
• Permit us to obtain credit information, verify information you have
provided, and perform a background check on you, and to reject
or remove you as authorized agent from this or any other account,
at any time and for any reason we see fit.
• Agree to notify us in writing immediately upon the death or dis-
ability of the last surviving account owner.
• Acknowledge that you will not be paid for the investment man-
agement of the account(s). If you are looking to establish a
Registered Investment Advisor relationship, please contact Fidelity
Institutional Wealth Services.
Terms and Conditions — All Parties
Duration of Agent’s Authorization
Once granted to an authorized agent, trading authority will remain
in effect until any of the following occurs:
• We receive written notice signed by an owner withdrawing authority.
• We receive written notice of resignation from the authorized agent.
• We receive written notice of the death or incapacity of the last
surviving account owner or the authorized agent.
• We decide, at any time and for any reason, to remove the
authorized agent.
Indemnification
All account owners and the authorized agent agree that we are not
responsible for any losses you incur (meaning claims, damages,
actions, demands, investment losses, or other losses, as well as any
costs, charges, attorneys’ fees, or other fees and expenses) as a result
of any actions, or failures to act, on the part of the authorized agent.
Terms Concerning This Agreement
This agreement and its enforcement are governed by the laws of
the Commonwealth of Massachusetts, except with respect to its
conflicts-of-law provisions.
This agreement is in addition to any other agreements between the
parties and Fidelity and does not restrict any rights that may be cre-
ated, either now or in the future, by these agreements or by any law.
We may amend or terminate this agreement at any time. Outside of
changes originating in these ways, no provision of this agreement
can be amended or waived except in writing by an authorized rep-
resentative of Fidelity.
Fidelity may transfer its interests in this account or agreement to
any of its successors and assigns, whether by merger, consolidation,
or otherwise. You may not transfer your interests in your account
or agreement (including de facto transferal by giving a non-owner
access to the account using a PIN) except with the prior written
approval of Fidelity, or through inheritance, corporate dissolution, or
similar circumstance, as allowed by law, in which case any rights and
obligations in existence at the time will accrue to, and be binding
on, your heirs, executors, administrators, successors, or assigns.
Resolving Disputes — Arbitration
This agreement contains a pre-dispute
arbitration clause. Under this clause,
which you agree to when you sign your
account application, you and Fidelity
agree as follows:
A. All parties to this agreement are giv-
ing up the right to sue each other in
court, including the right to a trial by
jury, except as provided by the rules of
the arbitration forum in which a claim
is filed.
B. Arbitration awards are generally final
and binding; a party’s ability to have a
court reverse or modify an arbitration
award is very limited.
C. The ability of the parties to obtain doc-
uments, witness statements, and other
discovery is generally more limited in
arbitration than in court proceedings.
D. The arbitrators do not have to explain
the reason(s) for their award unless, in
an eligible case, a joint request for an
explained decision has been submitted
by all parties to the panel at least 20
days prior to the first scheduled hear-
ing date.
E. The panel of arbitrators may include a
minority of arbitrators who were or are
affiliated with the securities industry.
F. The rules of some arbitration forums
may impose time limits for bringing a
claim in arbitration. In some cases, a
claim that is ineligible for arbitration
may be brought in court.
G. The rules of the arbitration forum
in which the claim is filed, and any
amendments thereto, shall be incorpo-
rated into this agreement.
All controversies that may arise between
the account owner, authorized agent,
and Fidelity concerning any subject mat-
ter, issue, or circumstance whatsoever
(including, but not limited to, contro-
versies concerning any account, order,
distribution, rollover, advice interaction,
or transaction, or the continuation, per-
formance, interpretation, or breach of
this or any other agreement between
the parties, whether entered into or
arising before, on, or after the date any
account in Section 2 is opened) shall be
determined by arbitration in accordance
with the rules then prevailing of the
Financial Industry Regulatory Authority
(FINRA) or any United States securities
self-regulatory organization or United
States securities exchange of which
the person, entity or entities against
whom the claim is made is a member,
as you may designate. If you commence
arbitration through a United States self-
regulatory organization or United States
securities exchange and the rules of
that organization or exchange fail to be
applied for any reason, then you shall
commence arbitration with any other
United States securities self-regulatory
organization or United States securities
exchange of which the person, entity
or entities against whom the claim is
made is a member. If you do not notify
us in writing of your designation within
five (5) days after such failure or after
you receive from us a written demand
for arbitration, then you authorize
us to make such designation on your
behalf. The commencement of arbitra-
tion through a particular self-regulatory
organization or securities exchange is
not integral to the underlying agree-
ment to arbitrate. You understand that
judgment upon any arbitration award
maybe entered in any court of compe-
tent jurisdiction.
No person shall bring a putative or
certified class action to arbitration, nor
seek to enforce any predispute arbitra-
tion agreement against any person who
has initiated in court a putative class
action; or who is a member of a puta-
tive class action who has not opted out
of the class with respect to any claims
encompassed by the putative class
action until: (i) the class certification is
denied; or (ii) the class is decertified; or
(iii) the customer is excluded from the
class by the court. Such forbearance to
enforce an agreement to arbitrate shall
not constitute a waiver of any rights
under this agreement except to the
extent stated herein.
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FIDELITY INVESTMENT-ONLY (NON-PROTOTYPE) RETIREMENT ACCOUNT APPLICATION Boston

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Completed 3 January 2020

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