New Fidelity Account

1 Print Reset Save Questions? Go to or call 800-343-3548. New Fidelity Account Trust Brokerage Use this application to open a Fidelity Account for a trust. To open other Account types, visit 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, make a copy of the relevant page. Important to Understand Additional Documentation Requirements By signing this application, you acknowledge that: For domestic trusts, certification of trust can be accomplished F.

2 Idelity Brokerage Services LLC ( FBS ) will perform brokerage by signing this form. Some states require this certification to and administrative services. be notarized (see signatory page for specific states). You may obtain the notarization or attach a copy of the relevant pages N. ational Financial Services LLC ( NFS ) will provide of the trust document that provide the full name of the trust, administrative, clearing, and custody services. grantor(s), trustee(s), trust date, and the signature page(s) that FBS and NFS are together referred to herein as Fidelity .

3 Match the trustee(s) listed in this form, and all signatures. Do I mportant documents related to your Account include the not include the entire trust document. Fidelity Account Customer Agreement ( Customer For foreign trusts, include the relevant pages of your trust Agreement ) and other relevant information delivered from document that provide the full name of the trust, grantor(s), time to time. trustee(s), trust date, and all signature pages. Do not include I n this application, You, you, and your refers to all the entire trust document, and it must be in English.

4 Account holders, including individual, joint, trustees, and/or A. ny other required documents as indicated in the appropriate custodians. Each of the Account holders agrees that any Account sections of this application (if applicable). holder has authority to act on behalf of this Account . 1. Trust Information Trust Name Enter full trust name as evidenced by the trust document. For the Benefit of Provide the tax reporting Trust Social Security or Tax ID Number Date of Trust MM DD YYYY. number for the trust. A SSN OR TIN. decedent's SSN cannot be used as the tax For a domestic trust, provide the state.

5 For a foreign trust, provide the country.*. reporting number. * 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. If your trust is subject to foreign law, please tell us which country's laws apply. Trust Address This is the legal address used for tax reporting. Street Address City State ZIP Code Mailing Address This may be a PO Box, drop box, or c/o location. Same as residential address Default if no other information is indicated below.

6 Mailing Address City State ZIP Code Form continues on next page. Page 1 of 10 002662101. 2. Primary Trustee Information Provide the following information for the primary trustee. To provide information for any additional trustee(s), grantor(s), and/or any others with the authority to appoint/remove trustees and/or revoke/amend the trust, you can do so in Section 3 and have all trustees sign in Section 9. Do not make copies of Section 2 for additional individuals. Required. Trustee only Authority to appoint/remove trustees Authority to revoke the trust Check ALL that apply.

7 Trustee and grantor Authority to amend the trust rustee is an entity If the trustee is an entity, check the box, enter full entity name as evidenced by the relevant T. formation document ( , trust document, partnership agreement, articles of incorporation), and a completed Fidelity Brokerage Business Account Certification form, as applicable, is required. All required forms and supporting documentation must be provided at the time this application is submitted, or we will be unable to process this request. Enter full first and last First Name Middle Name Last Name name as evidenced by a government-issued, unexpired document ( , Entity Name driver's license, passport, permanent resident card).

8 Date of Birth MM DD YYYY Social Security or Taxpayer ID Number SSN OR TIN. Provide phone number(s) Primary Phone Secondary Phone to be used to verify and/or Mobile Number Mobile Number . authorize transactions. Email If you provided an email address, you have indicated your preference to receive communications electronically. Fidelity will email you instructions to enroll and consent to eDelivery of all eligible documents or you can go to to enroll once your Account is established. Residential Address This is the legal address used for tax reporting.

9 Street Address City State ZIP Code Mailing Address This may be a PO Box, drop box, or c/o location. Same as residential address Default if no other information is indicated below. Mailing Address City State ZIP Code Primary Trustee Information continues on next page. Page 2 of 10 002662102. 2. Primary Trustee Information, continued Citizenship citizen Indicate your citizenship status. Foreign citizen Information in this box must be completed. P. ermanent resident Nonpermanent resident Nonresident of Country of Citizenship Country of Tax Residency Only applicable to nonresidents of the Check one and attach City, State/Province, and Country of Birth a copy of a valid and unexpired government ID.

10 Showing number and photo. To claim tax status, Passport Employment Authorization Document also complete and submit an IRS Form W-8 BEN. DHS Permanent Resident Card Foreign National Identity Document Income Source Industry regulations require us to ask for this information. Check one and Employed: S. elf-employed: provide information. Occupation Employer Leave blank if self-employed. Employer Address City State/Province ZIP/Postal Code Country Retired: N. ot employed: Source of Income Pension, investments, spouse, etc. Associations As a person associated If you are employed by or associated with a broker-dealer, stock exchange, exchange member firm, the Financial with a member firm, you Industry Regulatory Authority (FINRA), a municipal securities dealer, or other financial institution, or are the spouse or are obligated to receive an immediate family member residing in the same household of someone who meets the aforementioned employ- consent from that firm.