Fillable New Fidelity Account Non-Retirement Brokerage (Fidelity Investments)

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New Fidelity Account Non-Retirement Brokerage (Fidelity Investments)

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1.930460.118 004522201 Page 1 of 9
Questions? Go to Fidelity.com/openaccount or call 800-343-3548.
New Fidelity Account
®
— Non-Retirement — Brokerage
Use this application to open the types of non-retirement accounts listed below. To open other account types, visit Fidelity.com for
the appropriate form. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room for information
or signatures, use a copy of the relevant page.
Important to Understand
By signing this application, you acknowledge that:
• Fidelity Brokerage Services LLC (“FBS”) will perform brokerage
and administrative services.
• National Financial Services LLC (“NFS”) will provide
administrative, clearing, and custody services.
• FBS and NFS are together referred to herein as “Fidelity.”
• Important documents related to your account include the
Fidelity Account Customer Agreement (“Customer
Agreement”) and other relevant information delivered from
time to time.
• In this application, “You,” “you,” and “your” refers to all
account holders, including individual, joint, trustees, and/or
custodians. Each of the account holders agrees that any account
holder has authority to act on behalf of this account.
Helpful to Know
Regarding this account:
Types of Accounts: Please consult your tax professional or state
laws to learn more about account types. Registration types
may vary by state.
Individual:
• Owned by one person.
Joint:
• Owned by at least two people.
• Joint owners do not need to be married.
Estate:
• Please call us to obtain additional documentation that must be
submitted with your application.
Conservator/Guardian:
• Include a copy of your court appointment with this application.
Custodial:
• Each state has its own rules, so indicating the minor’s state of
residency is important.
Other non-trust account:
• Use this option for other joint registration types, such
as usufruct and tenants by entirety.
• For additional information or for help filling out this application,
please call a Fidelity Representative at 800-343-3548.
1. Account Type
Individual
Joint: tenants with rights
of survivorship
Not available in Louisiana
Joint: tenants in common*
Joint: community property
Estate Individual Executor
Conservator/Guardian* Fiduciary
UGMA/UTMA (custodial):
State
Default if no state
indicated: minor’s
state of residence.
Other non-trust account:
Account Type
2. Account Owner
First Name Minor Middle Name Last Name
Estate/Entity Name Enter full entity name as evidenced by the relevant formation document (e.g., trust document, partnership agreement, articles of incorporation).
Social Security or Taxpayer ID Number Date of Birth MM DD YYYY
Primary Phone
Mobile Number
Secondary Phone
Mobile Number
Email
Check one.
* For account owners that are trusts or an entity, include a completed Trustee
Certification or Fidelity Brokerage Business Account Certification form, as
applicable, along with this form. Go to Fidelity.com/forms to download the forms.
Enter full first and last
name as evidenced by
a government-issued,
unexpired document (e.g.,
driver’s license, passport,
permanent resident card).
Provide phone number(s)
to be used to verify and/or
authorize transactions.
Account Owner continues on next page.
Print
Reset
Save
If you provide an email address and unless you indicate otherwise below, all materials will be sent to you
electronically.
To confirm electronic delivery, respond to the Electronic Delivery Agreement and Consent, which Fidelity will email
to you. To choose delivery by U.S. mail, check one or more boxes below.
Account statements
Trade confirmations and related prospectuses
Tax forms and related disclosures
Other documents (including shareholder reports and regular prospectus mailings)
Residential Address (where you live) This is your legal address used for tax reporting.
Street Address
City State ZIP Code
Mailing Address This may be a P.O. box, drop box, or c/o location.
Same as residential address
Default if no other information indicated below.
Mailing Address
City State ZIP Code
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
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.
Check only those
items you do NOT
want to receive
electronically.
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government ID
showing number and photo.
To claim non-U.S. tax status,
also complete and submit an
IRS Form W-8BEN.
Check one and
provide information.
Industry regulations
require us to ask for
this information.
Page 2 of 91.930460.118 004522202
Account Owner continues on next page.
2. Account Owner, continued
Page 3 of 9
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
Affiliations
If you, your spouse, or any of your relatives (including parents, in-laws, and/or dependents, etc.), living in your home
(at the same address), is a member of the board of directors, a 10% shareholder, or a policy-making officer of a publicly
traded company (an “Affiliate”), you must provide the information below. If there are more than two Affiliates, make a
copy of this section.
Affiliate’s Company Name Trading Symbol or CUSIP
Affiliate’s Company Name Trading Symbol or CUSIP
3. Additional Account Owner
First Name Minor Middle Name Last Name
Estate/Entity Name Enter full entity name as evidenced by the relevant formation document (e.g., trust document, partnership agreement, articles of incorporation).
Social Security or Taxpayer ID Number Date of Birth MM DD YYYY
Primary Phone
Mobile Number
Secondary Phone
Mobile Number
Email
If you provide an email address and unless you indicate otherwise below, all materials will be sent to you electronically.
To confirm electronic delivery, respond to the Electronic Delivery Agreement and Consent, which Fidelity will email
to you. To choose delivery by U.S. mail, check one or more boxes below.
Account statements
Trade confirmations and related prospectuses
Tax forms and related disclosures
Other documents (including shareholder reports and regular prospectus mailings)
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.
Enter full first and last
name as evidenced by
a government-issued,
unexpired document (e.g.,
driver’s license, passport,
permanent resident card).
Provide phone number(s)
to be used to verify and/or
authorize transactions.
Check only those
items you do NOT
want to receive
electronically.
1.930460.118 004522203
Additional Account Owner continues on next page.
2. Account Owner, continued
Page 4 of 91.930460.118 004522204
Residential Address (where you live) This is your legal address used for tax reporting.
Street Address
City State ZIP Code
Mailing Address This may be a P.O. box, drop box, or c/o location.
Same as residential address
Default if no other information indicated below.
Mailing Address
City State ZIP Code
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.
Indicate your
citizenship status.
Check one and attach
a copy of a valid and
unexpired government ID
showing number and photo.
To claim non-U.S. tax status,
also complete and submit an
IRS Form W-8BEN.
Check one and
provide information.
3. Additional Account Owner, continued
Additional Account Owner continues on next page.
Page 5 of 91.930460.118 004522205
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 afore-
mentioned employment 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
Affiliations
If you, your spouse, or any of your relatives (including parents, in-laws, and/or dependents, etc.), living in your home
(at the same address), is a member of the board of directors, a 10% shareholder, or a policy-making officer of a publicly
traded company (an “Affiliate”), you must provide the information below. If there are more than two Affiliates, make a
copy of this section.
Affiliate’s Company Name Trading Symbol or CUSIP
Affiliate’s Company Name Trading Symbol or CUSIP
4. Core Position
Your core position (“Core Position”) is where your money is held until you invest it. For your Core Position, please select from the options listed below.
Fidelity Government Money Market Fund (SPAXX) Default if no choice is indicated.
Fidelity Treasury Money Market Fund (FZFXX)
FCASH (Taxable Interest-Bearing Cash Option)
There may be other options available for your Core Position in addition to the ones listed above. If so, you can change your Core Position
to one of these other options after your account is opened. For more information about how to do this, please contact Fidelity. In certain
circumstances, such as when Fidelity determines that you reside outside the United States, the Core Position will operate differently. Please
refer to the Customer Agreement for further details.
5. Initial Funding This is a one-time contribution.
Check all funding options that apply to this one-time transfer.
By check payable to Fidelity Brokerage Services LLC.
This must be a check written by you, as third-party
checks cannot be accepted.
Transfer from another firm
Include a completed “Transfer of Assets” form available at Fidelity.com/toa.
Transfer from your Fidelity non-retirement account:
If entire account value is transferred, the source account
will be closed. Account features do not transfer and must be reestablished for the new account.
Brokerage Account
Your Fidelity Brokerage Account Number Amount Must be available as cash.
OR
$
All Assets
.
Mutual Fund Only Account
Your Fidelity Mutual Fund Only Account Number Fidelity Fund Name
Dollar Amount
OR
Number of Shares
OR
$
Transfer All Shares
.
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.
Your name and
SSN must be
identical on both
accounts.
Form continues on next page.
3. Additional Account Owner, continued
Page 6 of 9
6. Ongoing Funding Options
Electronic Funds Transfer (EFT)
See “Important Information about Electronic Funds Transfer (EFT)” at the end of this application.
EFT allows you to electronically transfer funds between your bank or other financial institution and Fidelity. This section must be completed
for automatic investments from outside Fidelity. Not ready to sign up now? Log in to Fidelity.com/eft after your account has been opened
to establish EFT.
You must be an owner of the account at the other financial institution. You will need to attach a voided check, deposit slip, or bank state-
ment with the account number and all owner names preprinted on it.
Checking
Savings
Provide bank information below to set up the EFT feature.
Owner(s) Name(s) Exactly as on Bank Account
Bank Routing/ABA Number
Bank Name
Checking or Savings Account Number
Automatic Investments
Automatic Investments may be set up at any time to direct Electronic Funds Transfer that are held in your Core Position into the
investment vehicle of your choice. This can be established by visiting Fidelity.com/AutoInvest or by completing the enclosed Automatic
Investment form.
Income and Dividends
All income from securities (dividends, capital gains, or sale proceeds) is automatically deposited into your account. Dividends from mutual
funds are reinvested in the originating fund. To change your distributions, call Fidelity or log on to Fidelity.com/updateaccountfeatures.
7. Account Features
Additional account features are available for your new account. You may establish most of these online at Fidelity.com/updateaccountfeatures.
Or, you may choose from the following:
Checkwriting
Establish now — Checkwriting form is included with this application.
Please send information to establish checkwriting in the future.
Establish Fidelity BillPay
®
.
Request Active Trader. To sign up later, call a trading specialist at 800-564-0211.
Trades per year 36–119 120+
Send me information on EFT (Electronic Funds Transfer).
Send me information on Automatic Investments.
Debit Cards
Fidelity offers debit cards on only Individual and Joint accounts. You may establish this online at Fidelity.com/updateaccountfeatures. Or,
you may choose from the following:
Order me a Fidelity
®
Debit Card.
Order a second card for the Additional Account Owner.
1.930460.118 004522206
Form continues on next page.
8. Account Owner Signatures and Dates
Please be sure to read all the language included on the following pages, as well as sign, date, and return all pages of
this application (1–9) to Fidelity.
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 IRS does not require your consent to any
provision of this document other than the certi-
fications required to avoid backup withholding.
You acknowledge that this account is governed by a predispute arbitration
clause, which appears on the last page of the Customer Agreement, and that
you have read the predispute arbitration clause.
By signing below, you acknowledge that you have read, understand, and agree to be bound by the provisions of this application,
including the Terms and Conditions for This Account on the following pages.
PRINT OWNER NAME
PRINT OWNER TITLE REQUIRED (E.G., TRUSTEE, GUARDIAN, CONSERVATOR)
OWNER SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
X
587468.18.0
PRINT OWNER NAME
PRINT OWNER TITLE REQUIRED (E.G., TRUSTEE, GUARDIAN, CONSERVATOR)
OWNER SIGNATURE
SIGN
X
TODAY’S DATE MM/DD/YYYY
DATE
X
Page 7 of 9 004522207 1.930460.118
Form continues on next page.
If you are a U.S. person for tax purposes:
• Certify under penalties of perjury that
you are a U.S. person (including a U.S.
resident alien or other U.S. person as
defined in the instructions to IRS Form
W-9) and the Social Security or Taxpayer
Identification Number provided is correct
(or that you are waiting for a number to
be issued to you).
• Certify under penalties of perjury that you
are not subject to backup withholding
because any of the following applies:
– You are exempt from backup withholding.
– You have not been notified by the
Internal Revenue Service (IRS) that you
are subject to backup withholding as a
result of a failure to report all interest
or dividends.
– The IRS has notified you that you are no
longer subject to backup withholding.
• Certify under penalties of perjury that the
FATCA code(s) entered on this form (if
any) indicating that you are exempt from
FATCA reporting are correct.
If you are not a U.S. person for
tax purposes:
• You are submitting the applicable
Form W-8 with this form to certify your
foreign status and, if applicable, claim
tax treaty benefits.
If the IRS has notified you that you are
currently subject to backup withholding
because you failed to report all interest
and dividends on your tax return,
CROSS OUT all text in brackets.
Page 8 of 9 004522208 1.930460.118
9. Terms and Conditions for This Account
By signing the previous section, you:
• Affirm that you are at least 18 years old and
of full legal age to enter into the agree-
ments associated with this application in
your state of residence.
• Represent and warrant that if you have not
completed the section titled Associations,
you are not employed by nor associated
with a broker-dealer, stock exchange,
exchange member firm, FINRA, a municipal
securities dealer, nor any other financial
institution, nor are you the spouse or imme-
diate family member residing in the same
household of such a person.
• Represent and warrant that if you have not
completed the section titled Affiliations,
none of you, your spouse, nor any of your
relatives living in your home are a control
person or affiliate of a public company
under SEC Rule 144.
• Acknowledge that you agree to the use
of the Core Position to hold any assets of
your account pending investment or other
instructions and that you have received and
read the prospectus for the Core Position.
• Affirm that you have received, read,
understood, and agree to be bound by
the terms and conditions of the Customer
Agreement, this Application (including,
if applicable, the Important Information
regarding Electronic Funds Transfer (EFT)
and the Margin Agreement) and the
Schedule of Fees (which is incorporated
into the Agreement by reference and
legally forms a part of that document), as is
currently in effect and as may be amended
in the future. It shall inure to the benefit of
Fidelity’s successors and assigns, whether
by merger, consolidation, or otherwise.
Fidelity may transfer your account to its
successors and assigns, and this Agreement
shall be binding upon your heirs, executors,
administrators, successors, and assigns.
• Acknowledge that you have received the
description of the Core Position 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.
• Acknowledge that if no choice is indicated,
the default Core Position will be the core
account indicated in the Core Position section.
• Understand that your Core Position
may be a money market fund, and that
you could lose money by investing in a
money market fund. Although the fund
seeks to preserve the value of your
investment at $1.00 per share, it cannot
guarantee it will do so. An investment
in the fund is not insured or guaran-
teed by the Federal Deposit Insurance
Corporation or any other government
agency. Fidelity Investments and its affil-
iates, the fund’s sponsor, have no legal
obligation to provide financial support
to money market funds and you should
not expect that the sponsor will provide
financial support to the fund at any time.
• Understand that Fidelity’s government and
U.S. Treasury money market funds will not
impose a fee upon the sale of your shares,
nor temporarily suspend your 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.
• Consent to have only one copy of Fidelity
mutual fund shareholder documents, such
as prospectuses and shareholder reports
(“Documents”), delivered to you and
any other investors sharing your address.
Your Documents will be householded
indefinitely; however, you may revoke this
consent at any time by contacting Fidelity
at 800-343-3548 and you will begin receiv-
ing multiple copies within 30 days. As
Documents for other investments become
available in the future, these Documents
may also be householded in accordance
with this authorization or any notice or
agreement you received or entered into
with Fidelity or its service providers.
• Understand that, upon issuer’s request
in accordance with applicable rules and
regulations, Fidelity will supply your name
to issuers of any securities held in your
account so you might receive any important
information regarding them, unless you
notify Fidelity.
• Understand that it is your responsibility to
read the prospectus or other applicable
documents for the Core Position.
• Acknowledge that you have received and
read either the full prospectus or summary
prospectus for that fund.
• Acknowledge that if the prospectus you
received was the summary prospectus, you
have the right to request and review the full
prospectus before you invest in the fund.
• Agree to indemnify and hold Fidelity harm-
less from and against any and all losses,
liabilities, claims, and costs (including rea-
sonable attorneys’ fees) that are in any way
connected with your instructions or with
any telephone, Internet, or other electronic
request for redemption so long as Fidelity
transmits the redemption proceeds to the
bank account identified above. You further
agree that the indemnifications in this
bullet are in addition to, and do not limit,
any rights that Fidelity may have under any
other agreement with you.
• Acknowledge that Fidelity will not be liable
for any loss, cost, or expense arising out of
your instructions, provided that it institutes
reasonable procedures to prevent unautho-
rized transactions.
• Hereby constitute and appoint Fidelity your
true and lawful attorney to surrender for
redemption any and all shares held in the
above-indicated accounts with full power of
substitution in the premises.
• Acknowledge that Fidelity reserves the
right to cease to act as agent in connection
with the above appointment after provision
of notice to the address noted on this form.
• Certify and agree that the certifications,
authorizations, and appointments in this
document will continue until Fidelity
receives actual written notice of any change
thereof.
• Agree to be responsible for any and all fees
and charges that apply to the account.
• Upon transfer of assets due to any life
event (death, divorce, etc.), and unless
otherwise instructed, all dividend/interest
income paid to the Transferor (Current
Asset Holder) of $100 or less will be
systematically allocated to the Transferee
(New Asset Holder) receiving the largest
share proportion of the account assets. If the
account is transferred evenly, the dividend/
interest income will be systematically
allocated to the last transferee paid.
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 prevent
unauthorized transactions.
• Certify that all information provided to us in
this form is true, accurate, and complete.
• Acknowledge that 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.
If requesting EFT:
• Acknowledge that you have read and
agree to the Important Information about
Electronic Fund Transfer document.
• Authorize Fidelity, upon receiving
instructions from you, to make payments
of amounts representing redemptions
by you or distributions payable to you
by initiating credit or debit entries to
the bank account identified in Section 6
(Bank), as indicated on the attached
“voided” check or deposit slip. You
authorize and request the Bank to accept
such entries from Fidelity, and to credit
or debit, as indicated, your account at the
Bank in accordance with these entries.
• Acknowledge that this authorization may
only be revoked by providing written
notice of revocation to Fidelity, in such
time and manner as afford Fidelity and
the bank a reasonable opportunity to act
upon it.
• Understand that Fidelity may purge
unused EFT instructions from my account
on a periodic basis without notice to me.
• Understand that Fidelity may terminate
the EFT instructions from my account at
any time in its sole discretion.
Page 9 of 9 0045222091.930460.118
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. All trademarks and service marks used
herein are the property of their respective owners. 587468.18.0 (08/20)
Did you sign the form and attach a check or any necessary documents?
Please return pages 1–9 and any necessary attachments. You will receive
a “New Account Profile” confirming that your account(s) is opened.
Questions? Go to Fidelity.com/openaccount or call 800-343-3548.
Regular mail
Fidelity Investments
P.O. Box 770001
Cincinnati, OH 45277-0002
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
Page 1 of 2
Questions? Go to Fidelity.com/trustedcontact or call 800-343-3548.
Trusted Contact Authorization Form
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 Name, email, phone, and address are all required.
First Name Middle Name Last Name
Email Relationship to Owner (Spouse, Child, Parent, Sibling, Friend, Other)
Primary Phone
Mobile
Number
Secondary Phone
Mobile
Number
Legal/Permanent Address
Street Address
City State/Province ZIP/Postal Code Country
Check only one.
The trusted contact
MUST be someone
other than the individual
listed in Section 1. Do
not provide the account
owner’s information here.
This cannot be a
PO box, mail drop,
or c/o.
1.9883825.102 037430201
Form continues on next page.
Page 2 of 21.9883825.102 037430202
4. Alternate Trusted Contact Name, email, phone, and address are all required.
First Name Middle Name Last Name
Email Relationship to Owner (Spouse, Child, Parent, Sibling, Friend, Other)
Primary Phone
Mobile
Number
Secondary Phone
Mobile
Number
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 provided in this
form is true, accurate, and complete.
• 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
The trusted contact
MUST be someone other
than the individuals listed
in Sections 1 and 3. Do
not provide the account
owner’s information here.
This cannot be a
PO box, mail drop,
or c/o.
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 802990.3.0 (06/20)
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
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)
Questions? Go to Fidelity.com/autoinvest or call 800-343-3548.
Automatic Investments — Transaction Policies
It can take up to 4 days to complete your transaction. During this period, the assets being invested will not appear in the account balance
for either of the accounts involved. As noted in the table below, transaction processing can take even longer if there are insufficient funds in
the source account.
All automatic investments involve two distinct transactions: a withdrawal from the source account and a deposit/investment into the receiv-
ing account. As noted in the table below, in some cases the investment transaction may go forward even if the withdrawal transaction that
funds the investment does not occur due to insufficient funds.
Transaction Type Time Frame If Insufficient Funds
From bank/financial institution to
brokerage account core position
Funds will generally leave the
bank/financial institution at least
2 days prior to the trade date.
• Investment portion of transaction occurs, unless prohibited
by bank/financial institution.
• Bank may subsequently demand return of cash to
satisfy overdraft.
• Your bank/financial institution may charge transaction and/or
overdraft fees.
• You may need to contact your bank/financial institution to
restart automatic transactions.
From bank/financial institution
to purchase mutual fund
Funds will generally leave the
bank/financial institution at least
2 days prior to the trade date.
• Investment portion of transaction occurs, unless prohibited
by bank/financial institution.
• If we do not receive full amount within 3 days, we will
record a debit balance on your account and cancel future
automatic investments.
• Your bank/financial institution may charge transaction and/or
overdraft fees.
• You may need to contact both your bank/financial institution
and Fidelity to restart automatic transactions.
Within the same account:
- From core position to
mutual fund
- From one mutual fund
to another
Transaction begins 2 days prior
to the trade date.
• Investment portion of transaction occurs.
• All available assets will be applied toward the transaction.
• If no further assets appear in the source account within
3 days, we will record a debit balance on your account for
the insufficient amount.
Between two Fidelity accounts:
- From core position or mutual
fund in one brokerage account to
core position in another broker-
age account
- From one Mutual Fund Only
account to another Mutual Fund
Only account
The withdrawal from the source
account generally begins 4 days
in advance of the trade date.
For retirement accounts, invest-
ments from another account
are placed in your core position
for three days prior to being
invested in any mutual funds you
may have designated.
• Investment portion of transaction occurs.
Nonretirement accounts:
• If funds are not available at the end of the settlement period
(0 days for core positions, 3 days for mutual fund positions), a
debit balance will occur.
• An attempt is made to sell for 3 days (6 days for plans that are
offered an immediate payment feature). Each day, we remove
any available assets to apply toward the transaction.
Fidelity managed accounts:
• If no further assets appear in the source account within
15 days, transaction is canceled without notice to you.
Future transactions are not affected.
Page 1 of 11.9866000.101
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 728535.2.0 (05/18)
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Completed 22 February 2021

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