Trust Account Application
Trust Account Application
Trust Account Application
1. Trust Information
Trust Name Enter full trust name as evidenced by the trust document.
Provide the tax reporting Trust Taxpayer ID Number Required Date of Trust MM DD YYYY
number for the trust. A
decedent’s SSN cannot SSN/ITIN Entity ID/TIN
be used as the tax For a domestic trust, provide the state. For a foreign trust, provide the country.*
reporting number.
The SSN must be that of
a living grantor. *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
Residential Address This is the legal address used for tax reporting.
Street Address
Citizenship
Choose one. Permanent U.S. resident Nonpermanent U.S. resident Nonresident of U.S.
Employer Address
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 employment
consent from that firm. criteria, provide the company’s name and address below. Information (including duplicate copies of confirmations and
Fidelity has existing statements for this account, and any accounts you choose to have on a consolidated statement) will be sent to the asso-
consent agreements ciated person’s employer for purposes of compliance review.
with many firms for
Company Name
their employees to
maintain accounts with
Fidelity and to deliver
transactional data. If Company Address
your firm is not one
of them, Fidelity will
attempt to contact your City State/Province ZIP/Postal Code Country
firm’s compliance office.
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
Residential Address This is the legal address used for tax reporting.
Street Address
Citizenship
Choose one. P
ermanent U.S. resident Nonpermanent U.S. resident Nonresident of U.S.
R
etired: N
ot employed:
Source of Income Pension, investments, spouse, etc.
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
OR All Assets
5. Core Position
Any cash balances awaiting your further instruction will be swept into the Fidelity Government Money Market Fund (SPAXX) (referred to as
your “Core Position”). There may be other options available for your Core Position. If so, you can change your Core Position to one of these
other options after your account is opened.
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.
C
hecking Savings
Provide bank Owner(s) Name(s) Exactly as on Bank Account
information to set up
the EFT feature.
Bank Routing/ABA Number Bank Name
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.
Ongoing Funding Options continues on next page.
7. A
ccount 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
stablish now — You must include the Checkwriting form with this application. Go to Fidelity.com/forms to
E
download the form.
Please send information to establish checkwriting in the future.
Establish Fidelity BillPay®.
Order me a Fidelity® Debit Card.
Order a second card for the Additional Account Owner.
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 automatic investments.
8. Certification of Trust
By signing on the next page, you certify as Trustee that:
• The trust has not been revoked, modified, and issue the instructions that you make require, and each trustee may act inde-
or amended in any manner that would on behalf of the Trust account with Fidelity. pendently.
cause the statements contained in this trust The Trustees understand that all such trans- • Fidelity is authorized to follow the instruc-
certification to be incorrect. actions and instructions will be governed tions of any Trustee and to deliver funds,
• The trust exists under all applicable laws. by the terms and conditions of all other securities, or any other assets in the
account agreements applicable to this account to any Trustee on any Trustee’s
• There are no Trustees of the Trust other
account. The Trustees, jointly and severally, instructions, including delivering assets
than those listed above. Every trustee
indemnify Fidelity and hold Fidelity harm- to a Trustee personally. Fidelity, in its sole
(whether you are the sole trustee or there
less from any claim, loss, expense, or other discretion and for its sole protection, may
is more than one) has signed below and
liability for acting pursuant to the instruc- require the written consent of any or all
is authorized to make these statements.
tions given by the Trustees. The Trustees Trustees before acting on the instructions
Should only one person execute this agree-
further agree not to give any instructions of any Trustee.
ment, it shall be a representation that the
for which they are not in full compliance • If included, the pages of the Trust doc-
signer is the sole Trustee.
with the Trust. ument are true copies of the valid legal
• You agree to inform Fidelity, in writing,
• Fidelity has the authority to accept instruc- document currently in effect.
of any change in the composition of the
tions relative to the account from those • Where applicable, plural references in this
Trustees, or any other event that could alter
individuals listed as Trustees in Sections 2 certification shall be deemed singular.
the certifications made herein.
and 3. They may execute any documents
• You have the authority under the trust and on behalf of the Trust that Fidelity may
applicable law to enter into transactions
9. A
ccount Owner Signatures and Dates ALL trustees must sign and date this application.
Please be sure to read all the language included on the following pages, as well as sign, date, and return your
completed application, including this signature page, to Fidelity.
If you are a U.S. person for tax purposes: • Certify under penalties of perjury that you • Certify under penalties of perjury that the
•C
ertify under penalties of perjury that are not subject to backup withholding FATCA code(s) entered on this form (if
you are a U.S. person (including a U.S. because any of the following applies: any) indicating that you are exempt from
resident alien or other U.S. person as – You are exempt from backup withholding. FATCA reporting are correct.
defined in the instructions to IRS Form – You have not been notified by the If you are not a U.S. person for
W-9) and the Social Security or Taxpayer Internal Revenue Service (IRS) that you tax purposes:
Identification Number provided is correct are subject to backup withholding as a
result of a failure to report all interest • You are submitting the applicable
(or that you are waiting for a number to
or dividends. Form W-8 with this form to certify your
be issued to you).
foreign status and, if applicable, claim
– The IRS has notified you that you are no
If the IRS has notified you that you are tax treaty benefits.
longer subject to backup withholding.
currently subject to backup withholding
because you failed to report all interest
and dividends on your tax return,
CROSS OUT all text in brackets.
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 You acknowledge that this account is governed by a predispute arbitration
provision of this document other than the certi- clause, which appears on the last page of the Customer Agreement, and that
fications required to avoid backup withholding. 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.
If a copy of the relevant pages from a domestic trust are not being provided, all trustee signatures MUST be notarized if your trust
is governed by the laws of any of the following states: California, Delaware, Idaho, Iowa, Kansas, Michigan, Minnesota, Mississippi,
Nebraska, Nevada, South Dakota, Tennessee, and Vermont. Refer to your trust document to determine which state’s law applies.
X X X X
SIGN
SIGN
Important Note: CA Notaries are permitted to submit a separate page notary document. If used, it must identify the document being notarized.
Notice to CA Residents: A Notary Public or other officer completing this certificate verifies only the identity of the individual
who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
Certificate of Acknowledgment of Notary Public Must be Certificate of Acknowledgment of Notary Public Must be
a U.S. Notary. Foreign notary or consular seals may NOT be substituted. a U.S. Notary. Foreign notary or consular seals may NOT be substituted.
before me by the above-named trustee who is personally known to before me by the above-named trustee who is personally known to
as identification, that the foregoing statements were true as identification, that the foregoing statements were true
and accurate and made of his/her own free act and deed, on and accurate and made of his/her own free act and deed, on
______/______/____________ . ______/______/____________ .
PRINT NOTARY NAME PRINT NOTARY NAME
X X X X
SIGN
SIGN
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. 446304.23.0 (12/23)
Helpful to Know
• To prepare yourself and your trusted contact(s) for success, • If Fidelity has questions or concerns about your health or welfare
consider choosing someone with whom you are comfortable due to potential diminished capacity, financial exploitation or
discussing your health, relationships, loved ones, work, abuse, endangerment, and/or neglect, this form authorizes us to
and finances. You may also want to consider selecting get in touch with the trusted contact(s) and:
someone who isn’t currently involved in your financial life, – Provide the trusted contact(s) listed below with information
like a beneficiary or power of attorney, to ensure fairness about you and/or your account(s), including notice of a
and objectivity. temporary hold, but does not provide him or her with the
• This form supersedes any previous trusted contact ability to transact on your account(s).
designations that you may have submitted. – Inquire about your current contact information or
• If you are using this form for an Entity relationship (for ex: a health status.
business account), we will assign the Trusted Contact(s) to the – Inquire about whether another person or entity has legal
Authorized Individual that signs this form. authority to act on your behalf (e.g., legal guardian or
conservator, executor, or trustee).
1. Account Owner
First Name Middle Name Last Name
2. Accounts Included
Check only one. 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
3. Primary Trusted Contact Name, email, phone, and address are all required.
The trusted contact First Name Middle Name Last Name
MUST be someone
other than the individual
listed in Section 1. Do Email Relationship to Owner (Spouse, Child, Parent, Sibling, Friend, Other)
not provide the account
owner’s information here.
Primary Phone Secondary Phone
Mobile Mobile
Number Number
Legal/Permanent Address
Street Address
This cannot be a
PO box, mail drop,
or c/o.
City State/Province ZIP/Postal Code Country
Legal/Permanent Address
Street Address
This cannot be a
PO box, mail drop,
or c/o.
City State/Province ZIP/Postal Code Country
5. Signature and Date Form cannot be processed without your signature and date.
X X
SIGN
Did you sign the form? Send the ENTIRE form to Fidelity. Regular mail Overnight mail
Fidelity Investments Fidelity Investments
Questions? Go to Fidelity.com/trustedcontact or call 800-343-3548. PO Box 770001 100 Crosby Parkway KC1K
Cincinnati, OH 45277-0002 Covington, KY 41015
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)
1.964554.105 Page 1 of 2
Important Information, continued
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 652049.6.0 (04/23)
1.964554.105 Page 2 of 2
Questions? Go to Fidelity.com/autoinvest or call 800-343-3548.
From bank/financial institution to Funds will generally leave the • Investment portion of transaction occurs, unless prohibited
brokerage account core position bank/financial institution at least by bank/financial institution.
2 days prior to the trade date. • 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 Funds will generally leave the • Investment portion of transaction occurs, unless prohibited
to purchase mutual fund bank/financial institution at least by bank/financial institution.
2 days prior to the trade date. • 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: Transaction begins 2 days prior • Investment portion of transaction occurs.
- From core position to to the trade date. • All available assets will be applied toward the transaction.
mutual fund • If no further assets appear in the source account within
- From one mutual fund 3 days, we will record a debit balance on your account for
to another the insufficient amount.
Between two Fidelity accounts: The withdrawal from the source • Investment portion of transaction occurs.
- From core position or mutual account generally begins 4 days
Nonretirement accounts:
fund in one brokerage account to in advance of the trade date.
• If funds are not available at the end of the settlement period
core position in another broker- For retirement accounts, invest- (0 days for core positions, 3 days for mutual fund positions), a
age account ments from another account debit balance will occur.
- From one Mutual Fund Only are placed in your core position • An attempt is made to sell for 3 days (6 days for plans that are
account to another Mutual Fund for three days prior to being offered an immediate payment feature). Each day, we remove
Only account invested in any mutual funds you any available assets to apply toward the transaction.
may have designated.
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.
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)
1.9866000.101 Page 1 of 1
Questions? Go to Fidelity.com/checkwriting.
Name/Address
• Be sure we have your correct name and address in our
records, because this is the information we will use when
we print and mail your checks.
• If updating your signature because of a name change,
complete and attach a Name Change form, as well
as appropriate documentation, such as a copy of a
marriage certificate or divorce decree.
Checkwriting
Use this form to:
• add checkwriting to an existing Fidelity nonretirement brokerage, mutual fund only, HSA, or Fidelity® Cash Management Account.
529 College Savings Plans, ABLE Accounts, and Fidelity managed accounts are NOT eligible to establish checkwriting.
• change or update signatures for account owners or authorized individuals (for example, because of a name change or to remove an individual).
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 this page.
1. Account Owner(s)
Name(s) Account Number
For business or trust
accounts, provide
entity name here, and
names and signatures Fidelity Fund Name or Symbol Required if your account number begins with a “2” and then any two letters.
of authorized individ
uals in Section 3.
2. Checkwriting Setup To change the account address before ordering checks, go to Fidelity.com/checkwriting.
By signing below, you agree to everything in the “Terms and Conditions” section of the previous page. Checkwriting can only be granted
to owners or to people who are already listed on the account as authorized individuals.
X X
SIGN
X X
SIGN
X X
S IGN
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 574789.11.0 (05/21)
On this form, “Fidelity” means Fidelity Brokerage Services LLC and National Financial Services LLC and
its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC.
574789.11.0 (05/21)