Fillable UNIQUE COLLEGE INVESTING PLAN (529) ACCOUNT APPLICATION (Fidelity Investments)

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UNIQUE COLLEGE INVESTING PLAN (529) ACCOUNT APPLICATION (Fidelity Investments)

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Please complete this application to establish a 529 Plan account with Fidelity Investments. One application must be
submitted for each account you wish to establish. Then, return your completed application(s) to Fidelity Investments,
P.O. Box 770001, Cincinnati, OH 45277-0036. If you have questions, simply call us at 800-544-1914.
UNIQUE COLLEGE INVESTING PLAN
(529) ACCOUNT APPLICATION
QUESTIONS?
For more information
800-544-1914
1
ACCOUNT SETUP
2
DESIGNATED BENEFICIARY
3
ESTABLISH A SUCCESSOR PARTICIPANT (ACCOUNT OWNER) ON
THIS ACCOUNT
4
INVESTMENT SELECTION
5
FUNDING YOUR ACCOUNT
6
ROLLOVER (OPTIONAL)
7
ACCOUNT OWNER SIGNATURE AND DATE
8
TERMS AND CONDITIONS FOR THIS ACCOUNT
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UNIQUE College Investing Plan (529 Plan) Account Application p. 1 of 7
1
ACCOUNT SETUP SELECT THE TYPE OF ACCOUNT YOU WOULD LIKE TO OPEN (REQUIRED)
All fields in bold are required for opening an account.
Note: On custodial and Trust 529 Plan Accounts you may not establish a successor participant designation.
Individual Account (most common)
Individual 529 accounts are owned by the participant for the benefit of the designated beneficiary on the account. The
participant maintains control of the account and can change the designated beneficiary.
UGMA/UTMA (Custodial) Account: I wish to invest UGMA/UTMA assets into this Custodial 529 Plan Account. The
minor will be the owner of this account and their Social Security number (SSN) will be used for tax reporting purposes.
1. Provide the Custodian’s information below.
2. Provide the Minor’s information in Section 2.
3. Provide the state under which the Uniform Gifts/Transfers to Minors is held: .
Trust Account: I wish to establish a trust as the Participant of this 529 Plan account.
Bank Deposit Portfolio is not an eligible investment selection for Trust Account Registrations.
1. Provide the Trust Name and Tax ID number below.
2. Provide the date on which the Trust was established:
3. Submit a completed Trustee Certification – Adding or Removing Trustees Form, signed by all trustees, to
Fidelity with this new account application. The Trustee Certification – Adding or Removing Trustees Form
is required to establish this account and can be found following this application or can be downloaded from
Fidelity.com/forms.
4. Submit one of the following:
a. Completed Fidelity Certification of Trust Form, which can be downloaded from Fidelity.com/cert-of-trust.
b. Copy of the trust pages that provide the full name of the trust and all trustee signatures.
PARTICIPANT (ACCOUNT OWNER) INFORMATION
Customer Name*
First Name Middle Name Last Name
*Enter full first and last name as evidenced by a government-issued, unexpired document (e.g., driver’s license, passport, permanent resident card).
Name of Trust
†
†
Enter full trust name as evidenced by the trust document.
Date of Birth (mm/dd/yyyy) Email Address
Social Security Number or Taxpayer ID Number
Residential Address (where you live)
Street
City State ZIP Code
Mailing address
(if different from above)
Street
City State ZIP Code
Phone Numbers Evening Day Ext.
This is your legal
address used for
tax reporting.
(no P.O. boxes)
1.790551.126 002931201
UNIQUE College Investing Plan (529 Plan) Account Application p. 2 of 7
1
ACCOUNT SETUP (CONTINUED)
Citizenship
I am a U.S. citizen.
I am a 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
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign National Identity Document
Employment status Employed Not employed Retired Occupation
(if retired or not employed, indicate source of income)
Self-Employed If you are self-employed and your company corporate address is the same as your legal home address,
please initial here that you work out of your home:
Employer’s name and address
Name
Street City State ZIP Code
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
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.
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.
1.790551.126 002931202
UNIQUE College Investing Plan (529 Plan) Account Application p. 3 of 7
2
DESIGNATED BENEFICIARY (STUDENT INFORMATION)
We assume the permanent address is the same unless otherwise noted.
Participant’s Relationship to Beneficiary (select one): Parent Grandparent Other
Full Legal Name*
First Name Middle Name Last Name
*Enter full first and last name as evidenced by a government-issued, unexpired document (e.g., driver’s license, passport, permanent resident card).
Date of Birth (mm/dd/yyyy) Email Address
Social Security Number or Taxpayer ID Number
Residential Address (where you live)
Street
City State ZIP Code
Mailing address
(if different from above)
Street
City State ZIP Code
Citizenship
I am a U.S. citizen.
I am a 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
City, State/Province, and Country of Birth
Passport
DHS Permanent Resident Card
Employment Authorization Document
Foreign National Identity Document
3
ESTABLISH A SUCCESSOR PARTICIPANT (ACCOUNT OWNER)
ON THIS ACCOUNT
(OPTIONAL) AVAILABLE FOR INDIVIDUAL ACCOUNT REGISTRATION ONLY
To name a Successor Participant on this 529 Plan account, you will need to provide the following information. This person
will become the account owner in the event of your death. You may update the Successor Participant on this account at any
time. Please note: THE SUCCESSOR PARTICIPANT MUST BE AT LEAST 18 YEARS OF AGE AND A U.S. RESIDENT. Also,
you may not name a Successor Participant on a Trust or Custodial 529 Plan account.
Full Legal Name Social Security or Taxpayer ID Number
Relationship to Participant Date of Birth (mm/dd/yyyy)
This is your legal
address used for
tax reporting.
(no P.O. boxes)
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.
1.790551.126 002931203
UNIQUE College Investing Plan (529 Plan) Account Application p. 4 of 7
4
INVESTMENT SELECTION
You can invest your 529 Plan contributions based on an Age-Based Strategy or a Custom Strategy. The Age-Based Strategies
are designed for your beneficiary’s age based on the date of birth listed in Section 2. Age-Based Portfolios are managed to
systematically shift in asset allocation from aggressive to conservative over time as the beneficiary approaches college age.
Until changed, all future 529 Plan contributions will be invested according to the investment instructions detailed in this
section. For more information about your investment options, please visit Fidelity.com/college, or refer to the UNIQUE
College Investing Plan Fact Kit.
Choose one option only
A selection is required. Your account cannot be established without your making
a strategy choice.
Age-Based Portfolios (Fidelity Funds) are designed to generate returns that attempt to beat a composite of major
market indices over the long term. These portfolios invest solely in Fidelity funds that are managed by dedicated
portfolio managers who are making investment decisions backed by Fidelity’s proprietary investment research.
Age-Based Portfolios (Fidelity Index) are designed to generate returns that closely mirror the performance of a
composite of major market indices over the long term. These portfolios invest solely in Fidelity Index funds, and
are able to keep transaction costs and other expenses low because they are passively managed. This means that
the securities currently held in the respective index determine your investments.
Age-Based Portfolios (Fidelity Blend) are designed to generate returns that attempt to beat a composite of major
market indices over the long term. These portfolios invest in a combination of Fidelity
®
domestic equity funds,
international equity funds, bond funds, and short-term funds (underlying Fidelity
®
funds), some of which are
actively managed and others of which are passively managed, meaning they seek to provide investment results that
correspond to the total return of a specific index.
Custom Strategy
Create your own investment mix from any of the 529 Plan Portfolios below (please use increments of 5%).
Age-Based Portfolio (Fidelity Funds) ______________ %
Age-Based Portfolio (Fidelity Index) ______________ %
Age-Based Portfolio (Fidelity Blend) ______________ %
Aggressive Growth Portfolio (Fidelity Funds) ______________ %
Moderate Growth Portfolio (Fidelity Funds) ______________ %
Conservative Portfolio (Fidelity Funds) ______________ %
Aggressive Growth Portfolio (Fidelity Index) ______________ %
Moderate Growth Portfolio (Fidelity Index) ______________ %
Conservative Portfolio (Fidelity Index) ______________ %
Fidelity
®
500 Index Portfolio ______________ %
Total Market Index Portfolio ______________ %
International Index Portfolio ______________ %
Intermediate Treasury Index Portfolio ______________ %
Money Market Portfolio* ______________ %
Bank Deposit Portfolio
†
______________ %
Total (must equal 100%) 100 %
* You could lose money by investing in this 529 money market investment option. Although the money market fund in which your investment
option invests (the “underlying fund”) seeks to preserve its value at $1.00 per share, the underlying fund cannot guarantee it will do so. An
investment in this 529 money market investment option is not insured or guaranteed by the Federal Deposit Insurance Corporation or any other
government agency. The underlying fund’s sponsor has no legal obligation to provide financial support to the underlying fund, and you should
not expect that the sponsor will provide financial support to the underlying fund at any time.
†
Although the underlying deposits are eligible for FDIC insurance, subject to applicable federal deposit insurance limits, the Units of the Bank
Deposit Portfolio are not insured or guaranteed by the FDIC or any other government agency. You are responsible for monitoring the total
amount of your assets on deposit at the depository bank, including amounts held directly at the depository bank. All such deposits held in the
same ownership capacity at the depository bank are subject to aggregation and to the current FDIC insurance coverage limitation of $250,000.
Please see a 529 fact kit for more details.
Bank Deposit Portfolio is not an eligible investment selection for Trust Account Registrations.
Please use increments of 5%.
1.790551.126 002931204
UNIQUE College Investing Plan (529 Plan) Account Application p. 5 of 7
5
FUNDING YOUR ACCOUNT
SEE “IMPORTANT INFORMATION ABOUT ELECTRONIC FUNDS TRANSFER (EFT)” AT THE END OF THIS APPLICATION.
INITIAL FUNDING (check any that apply)
If you are funding this account with a transfer from a Fidelity brokerage nonretirement account, please be sure funds are
available in your core account. If you are funding this account with proceeds from a Fidelity mutual fund account, your
mutual fund will be sold and subject to any applicable trading fees as specified in the fund’s prospectus.
A. Send a check.
Enclosed is a check for $ , made payable to Fidelity Brokerage Services LLC.
B. Transfer from a Fidelity nonretirement brokerage or mutual fund account (for initial investment or periodic
contributions).
Transfer $ from my Fidelity brokerage core account. Number
Sell (shares) or $ and transfer the proceeds from the
following Fidelity mutual fund: .
My account number is: .
C. Rollover from another Section 529 Plan, a Coverdell Education Savings account, or a qualified U.S. Savings Bond.
(If you check this box, you are required to read Section 6 of this application.)
PERIODIC CONTRIBUTIONS
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 statement 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.
1.790551.126 002931205
UNIQUE College Investing Plan (529 Plan) Account Application p. 6 of 7
6
ROLLOVER (OPTIONAL)
Read this section only if you are rolling over assets from another Section 529 Plan, a Coverdell Education Savings account,
or a qualified U.S. Savings Bond.
Check here if you would like Fidelity to initiate your rollover from another 529 Plan to fund this account. A Rollover
Form will be mailed to you after your 529 Plan account is established.
If you have already taken a distribution from another Section 529 Plan, a Coverdell Education Savings account, or a
qualified U.S. Savings Bond, please enclose a check (made payable to Fidelity Brokerage Services LLC) and appropriate
documentation showing the earnings portion of the rollover contribution. The chart below details the required appropriate
documentation based on the type of rollover contribution. Until Fidelity receives appropriate documentation reflecting the
earnings portion of the contribution, Fidelity must treat the entire amount of the contribution as earnings.
To perform this type of rollover... ...You must enclose the following appropriate documentation.
Rollover contribution from another 529 Plan A statement issued by the distributing 529 Plan provider that
shows the earnings portion of the distribution
Rollover contribution from a Coverdell Education An account statement issued by the financial institution that
Savings account acted as trustee or custodian of the education savings account
that shows basis and earnings in the account
Rollover contribution from the redemption of An account statement or Form 1099-INT issued by the financial
qualified U.S. Savings Bonds institution that redeemed the bonds showing interest from the
redemption of the bonds
7
ACCOUNT OWNER SIGNATURE AND DATE
Please be sure to read all the language included on the following pages, as well as sign, date, and return pages 1–7
when you submit this application to Fidelity.
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.
• The Internal Revenue Service does not require your
consent to any provision of this document other than
the certifications required to avoid backup withholding.
• This account is governed by a predispute arbitration
clause, which is located on the last page of the
Customer Agree ment. I acknowledge receipt of the
predispute arbitration clause.
By signing below, you acknowledge that you have read, understood, and agree to be bound by the provisions of this
application, including the Terms and Conditions for this Account, on the next page.
PRINT OWNER/TRUSTEE NAME
OWNER/TRUSTEE SIGNATURE
SIGN
X
TODAY’S DATE MM-DD-YYYY
DATE
454122.20.0
1.790551.126 002931206
454122.20.0 Fidelity Brokerage Services LLC, Member NYSE, SIPC 529CIT-APP-1120
© 2020 FMR LLC. All rights reserved.
1.790551.126 002931207
UNIQUE College Investing Plan (529 Plan) Account Application p. 7 of 7
8
TERMS AND CONDITIONS FOR THIS ACCOUNT
Participation Agreement:
By signing the previous section:
• I agree to participate in the UNIQUE College Investing Plan. I acknowledge that I have read, understood, and agree to the
terms and conditions set forth in the separate Participation Agreement.
• I understand that the Participation Agreement and its enforcement shall be governed by the laws of the State of
New Hampshire and is not subject to arbitration. It shall cover individually and collectively all accounts which I may
open or reopen. It shall inure to the benefit of the assigns, and the Participation Agreement shall be binding upon the
heirs, executors, administrators, successors, and assigns of the undersigned.
• I understand that it is my responsibility to read the Fact Kit. I have read, understood, and agree to the terms and
conditions set forth in the separate Fact Kit as is currently in effect and as may be amended from time to time.
• I hereby request Fidelity Brokerage Services LLC and National Financial Services LLC (collectively “Fidelity”) to open
a UNIQUE Plan brokerage account in the name listed as Participant on this application. In UGMA/UTMA 529 Plan
accounts, a UNIQUE Plan brokerage account is opened in the name of the custodian (listed as Participant on this
application) for the benefit of the Minor.
• I acknowledge that I have read, understood, and agree to the terms set forth in the Customer Agreement. I am at least
18 years of age and of full legal age in the state in which I reside. I understand that you will supply my name to issuers
of any securities held in my account so I might receive any important information regarding them, unless I notify you in
writing not to do so. I hereby ratify any telephone instructions given pursuant to this authorization and agree that Fidelity
will not be liable for any loss, liability, cost, or expense for acting upon such instructions. I understand that telephone
calls to Fidelity may be recorded, and I consent to such tape recordings.
• I understand that the Customer Agreement and its enforcement shall be governed by the laws of the Commonwealth
of Massachusetts. It shall cover individually and collectively all accounts I may open or reopen with Fidelity. It shall
inure to the benefit of Fidelity’s successors and assigns, and this Agreement shall be binding upon the heirs, executors,
administrators, successors, and assigns of the undersigned.
• For FAAB Customers Only: I hereby authorize and request Fidelity to secure payment of the amount indicated above to
be invested by me by initiating debit entries to the account indicated in the bank named above (“BANK”), and I authorize
and request the BANK to accept any such debit entries initiated by Fidelity to such account and to credit, as requested,
the same to my Fidelity account, without any further authorization relating hereto. I hereby ratify any instructions given
pursuant to this authorization and agree that Fidelity will not be liable for any loss, liability, cost, or expense for acting
upon such instructions.
• I consent to have only one copy of Fidelity mutual fund shareholder documents, such as prospectuses and shareholder
reports (“Documents”), delivered to me and any other investors sharing my address. My Documents, if held in eligible
accounts, will be householded indefinitely; however, I may revoke this consent at any time by contacting Fidelity at
800-343-3548 and I will begin receiving 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 I received or entered into with Fidelity or its service providers.
• I agree to adopt and be bound by the terms and conditions of the Customer Agreement, as is currently in effect and as may
be amended from time to time. I also certify that all information provided in this application is true, accurate, and complete.
If requesting EFT:
• I understand that Fidelity may purge unused EFT instructions from your account on a periodic basis without notice to you.
• I understand that Fidelity may terminate the EFT instructions from your account at any time in its sole discretion.
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.
Please tell us where you heard about the UNIQUE College Investing Plan offered by the State of New Hampshire
and managed by Fidelity Investments:
Newspaper TV Magazine Radio Friend/Referral
Direct Mail/Email Web Fidelity Branch Local Event
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UNIQUE COLLEGE INVESTING PLAN (529) ACCOUNT APPLICATION (Fidelity Investments)

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Completed 9 March 2021

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