Fidelity Certiﬁcation of Trust
Use this form to certify your trust to Fidelity. This form is for domestic trusts only. Do NOT use this form for foreign trusts. If your account
is in the name of a foreign trust, or if you prefer not to complete this form, certify your trust by providing pages of the trust document
that include the full name of the trust, trust date, name of the trustee(s), and all signatures. Do not include the entire trust document.
Some states require trustee signatures to be notarized (see page 2 for specific states).
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.
1. Trust Information ALL ﬁelds are required unless indicated otherwise.
Provide the tax reporting
number for the trust.
Trust Name Enter full trust name as evidenced by the trust document.
Trust Account Number Date of Trust MM DD YYYY
Trust Taxpayer ID/Social Security Number
Co-Trustee Name Required if there is more than one trustee. If there are more than two trustees, make copies of this form.
Name(s) of the person(s) who can AMEND the trust Field cannot be left blank.
Name(s) of the person(s) who can REVOKE the trust Field cannot be left blank.
Provide which state’s laws apply to your trust.*
* Your trust documents set forth the terms of your trust. Based on these documents, please tell us which state’s laws
apply to your trust.
2. Trustee Certiﬁcation ALL trustees must sign and date on the next page.
In this form, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC, National Financial Services LLC, and their afﬁliates; and their respective
employees, agents, representatives, shareholders, successors, and assigns as the context may require. “You” refers to the undersigned trustee(s).
Each trustee must sign and date this form. Make copies of this page and the next as needed.
By signing on the next page, you certify as trustee that:
• 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 trust has not been revoked, modiﬁed, or
amended in any manner that would cause the
statements contained in this trust certiﬁcation
to be incorrect.
• The trust exists under all applicable laws.
• There are no trustees of the trust other than
those listed above. Every trustee (whether
you are the sole trustee or there is more than
one) has signed below and is authorized to
make these statements. Should only one
person execute this agreement, it shall be a
representation that the signer is the sole trustee.
• You agree to inform Fidelity, in writing, of any
change in the composition of the trustees,
or any other event that could alter the
certiﬁcations made herein.
• You have the authority under the trust and
applicable law to enter into transactions and
issue the instructions that you make on behalf
of the trust account with Fidelity. The trustees
understand that all such transactions and
instructions will be governed by the terms and
conditions of all other account agreements
applicable to this account. The trustees further
agree not to give any instructions for which
they are not in full compliance with the trust.
• Fidelity has the authority to accept instructions
relative to the account from those individuals
listed as trustees in Section 1. They may
execute any documents on behalf of the trust
that Fidelity may require, and each trustee may
• Fidelity is authorized to follow the instructions
of any trustee and to deliver funds, securities,
or any other assets in the account to any
trustee 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 before acting on the
instructions of any trustee.
• All information provided in this form is true,
accurate, and complete.
• You agree to indemnify Fidelity (jointly and
severally) from and hold Fidelity harmless
for any and all losses, liabilities, claims, and
costs (including reasonable attorneys’ fees)
resulting from our effecting any transaction
or acting upon any instruction given by you
or any authorized agent, advisor, or any third
party you authorize on the account, or from
your action or inaction, whether intentional
or not, including losses resulting from the
action or inaction of any authorized agent,
advisor, or any other third party you authorize
on the account. 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.
• Where applicable, plural references in this
certiﬁcation shall be deemed singular.
Enter full first and last name as
evidenced by a government-issued,
unexpired document (e.g., driver’s
license, passport). If grantor/trustee
is an entity, enter full entity name as
evidenced by the relevant formation
document (e.g., trust document,
articles of incorporation).
Write “none” on
each line if there
Questions? Go to Fidelity.com or call 800-343-3548.
Trustee Certiﬁcation continues on next page.
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