Transcription of Trustee Certification — Adding or Removing Trustees
1 Trust Information ALL fields are the tax reporting number for the trust. A decedent s SSN cannot be used as the tax reporting Account NumberTrust Name Enter full trust name as evidenced by the trust Social Security or Tax ID Number SSNOR TINDate of Trust MM DD YYYYFor a domestic trust, provide the state. For a foreign trust, provide the country.** Your trust documents set forth the terms of your trust. Based on these documents, please tell us which state s lawsapply to your trust. If your trust is subject to foreign law, please tell us which country s laws Go to or call continues on next page. Trustee Certification Adding or Removing TrusteesUse this form to add or remove a Trustee (s) on your Fidelity Brokerage or Mutual Fund Only Trust, Fidelity Cash Management Trust, Trust 529 Plan, or Investment-Only account. Do NOT use this form if the trust s Taxpayer ID number (TIN or SSN) is changing. Instead, complete a Change of Account Registration form (brokerage), a Change of Account Ownership form (mutual fund), or a Fidelity Trust Account Application.
2 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 to Know To add or remove a Trustee on an existing account, ALLremaining Trustees MUST complete Sections 3 and 4,as applicable, and sign in Section 5. If the existing account has margin trading, optionstrading, and/or account authority, new forms must becompleted to maintain the features on the to obtain the necessary forms. If you have the ability to write a check on this account(even if you have never written one), you must alsocomplete a new Checkwriting form to add or remove atrustee on the associated signature card. If a debit card has been issued to a Trustee who is beingremoved from an account, you may call the number onthe back of the card at any time to request the card to beclosed. If the debit card remains open after a Trustee hasbeen removed, his or her debit card will be deactivated. If you are establishing a NEW Trust 529 Plan Account,a 529 Plan Account Application MUST accompany this Documentation Requirements Fidelity Certification of Trust form OR if your account is in the name of a foreign trust, or if youprefer not to complete the Fidelity Certification of Trust form,you will need to certify your trust by providing a copy ofthe pages of the trust document that includes the full nameof the trust, trust date, name of the updated or successortrustee(s) that match the Trustee (s) listed in this form, and allsignatures.
3 Do not include the entire trust document, andit must be in English. If your account is an Investment-Only account (also knownas a Non-Prototype account), you are required to providea copy of the pages of the plan or trust document thatincludes the full name of the plan or trust, plan or trustdate, name(s) of the updated or successor Trustee (s) thatmatch the Trustee (s) listed in this form, and all not include the Fidelity Certification of Trust form,or the entire trust or plan document. Any other required documents as indicated in theappropriate sections of this form (if applicable).Page 1 of Add or Remove Trustee (s)Complete the information below for each Trustee to be added or removed from the account. If there is more than one Trustee resigning, make one or more copies of this section and have all resigning Trustees complete and sign this section. All remaining and new Trustees , grantors, and any others with the authority to appoint/remove Trustees and/or revoke/amend the trust must provide their information in Sections 3 and 4, as applicable, and all Trustees must sign in Section 5.
4 Naming a successor Trustee (s)I (We)Name(s) of Successor Trustee (s)certify that I am (we are) the successor Trustee (s) of the above-named trust in accordance with the terms of the trust instrument. Adding a co- Trustee (s)I (We)Name(s) of Co- Trustee (s)certify that I am (we are) the co- Trustee (s) of the above-named trust in accordance with the terms of the trust instrument. Removing /Replacing a trusteeName of TrusteeReason: death of Trustee . Include a copy of the death certificate and a state tax waiver, if required by the decedent s state of residence. Incapacitation of Trustee . Include copies of the pages from the trust that govern the appointment of a successor Trustee , along with a letter signed by the attending physician on the physician s letterhead and dated within the past 90 days, which indicates a state of permanent mental incapacitation. Please do not send a copy of the whole trust. If the trust or plan has more stringent requirements for incapacitation, provide additional documentation as required to satisfy those requirements.
5 Resignation of Trustee . Resigning Trustee must sign below. Court order. Include a certified copy of the court order. Other Indicate ReasonResigning Trustee Signature By signing below, the undersigned hereby certifies that he or she is resigning as Trustee of the above-named Medallion signature guarantee is required if the value of the account is over $100, the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can get a Medallion signature guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a signature RESIGNING Trustee NAME RESIGNING Trustee SIGNATURE SIGNXTODAY S DATE MM-DD-YYYYDATEX MEDALLION SIGNATURE GUARANTEE Form continues on next page. Page 2 of Primary Trustee InformationProvide the following information for the primary Trustee . To provide information for any additional Trustee (s), grantor(s), or any others with the authority to appoint/remove Trustees and/or revoke/amend the trust remaining on the account OR being added to the account, you can do so in Section 4 and have all Trustees sign in Section 5.
6 Do not make copies of Section 3 for additional individuals. Trustee only Trustee and grantor Authority to appoint/remove Trustees Authority to revoke/amend the trust. Trustee is an entity If the Trustee is an entity, check the box, enter full entity name as evidenced by the relevant formation document ( , trust document, partnership agreement, articles of incorporation), and a completed Fidelity Trustee Certification or Fidelity Brokerage Business Account Certification form, as applicable, is required. All required forms and supporting documentation must be provided at the time this form is submitted, or we will be unable to process this NameMiddle NameLast NameEntity NameDate of Birth MM DD YYYYS ocial Security or Taxpayer ID Number SSN OR TINP rimary Phone Mobile NumberSecondary Phone Mobile NumberEmailIf 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 this request is Address (where you live) This is your legal address used for tax : This address will also be used to update the trust s permanent AddressCityStateZIP CodeMailing Address Including PO box, drop box, or c/o location.
7 Note: This address will also be used to update the trust s mailing address. Same as residential address Default if no other information is indicated AddressCityStateZIP CodeCitizenship citizen Foreign citizen Information in this box must be completed. Permanent resident Non-permanent resident Nonresident of of CitizenshipCountry of Tax Residency Only applicable to nonresidents of the , State/Province, and Country of Birth Passport DHS Permanent Resident Card Employment Authorization Document Foreign National Identity DocumentRequired. Check ALL that full first and last name as evidenced by a government-issued, unexpired document ( , driver s license, passport, permanent resident card).Provide phone number(s) to be used to verify and/or authorize your citizenship one and attach a copy of a valid and unexpired government ID showing number and Trustee Information continues on next page. Page 3 of Source Employed Self-employed OccupationEmployer Leave blank if AddressCityState/ProvinceZIP/Postal CodeCountry Retired Not employed Source of Income Pension, investments, spouse, 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 immedi-ate family member residing in the same household of someone who meets the aforementioned employment criteria, provide the company s name and address below.
8 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 NameCompany AddressCityState/ProvinceZIP/Postal CodeCountryAffiliationsIf 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 s Company NameTrading Symbol or CUSIPA ffiliate s Company NameTrading Symbol or CUSIPC heck one and provide regulations require us to ask for this a person associated with a member firm, you are obligated to receive consent from that firm.
9 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 Primary Trustee Information, continuedForm continues on next page. Page 4 of Additional Individual Information Provide the following information for each additional Trustee , grantor, and any others with the authority to appoint/remove Trustees and/or revoke/amend the trust remaining on the account OR being added to the account. If there are more than two individuals, make a copy of Section 4 and have all Trustees sign in Section 5. Trustee only Trustee and grantor Living Grantor only* DECEASED Grantor* Provide ONLY full legal name Authority to appoint/remove Trustees * Authority to revoke/amend the trust* Trustee is an entity If the Trustee is an entity, check the box, enter full entity name as evidenced by the relevant formation document ( , trust document, partnership agreement, articles of incorporation), and a completed Fidelity Trustee Certification or Fidelity Brokerage Business Account Certification form, as applicable, is required.
10 All required forms and supporting documentation must be provided at the time this form is submitted, or we will be unable to process this request.* These individuals will be listed as Beneficial Owners and will not have any authority or be able to take any action on this account or receive any account documentation, unless they are also Trustees or granted account authority. If the Beneficial Owner is an Entity, a separate Beneficial Ownership for Trusts form, or Beneficial Ownership Control Person/Entity Owner for Entities form, as applicable, must be NameMiddle NameLast NameEntity NameDate of Birth MM DD YYYYS ocial Security or Taxpayer ID Number SSN OR TINP rimary Phone Mobile NumberSecondary Phone Mobile NumberEmailIf 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 this request is Address (where you live) This is your legal address used for tax AddressCityStateZIP CodeMailing Address Including PO box, drop box, or c/o location.