EFTA00299834.pdf

Print Reset Save Oridefihr 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 ignatures, make a copy of the relevant page. Important to Understand Additional Documentation Requirements By signing this application, you adcnowledge that • Fidelity Certification of Trust form, provided with this • Fidelity Brokerage Services LLC ("FBS") will perform brokerage application, or it can be downloaded from and administrative services. • OR if your account is in the name of a foreign trust, or if you • National Financial Services LLC ("NFS") will provide prefer not to complete the Fidelity Certification of Trust form, administrative, clearing, and custody services. you will need to certify your trust by providing a copy of the pages of the trust document that includes the full name of the • FBS and NFS are together referred to herein as "Fidelity." trust, trust date, name of the updated or successor trustee(s) • Important documents related to your account include the that match the trustee(s) listed in this form, and all signatures. Fidelity Account Customer Agreement ("Customer Do not include the entire trust document. Agreement") and other relevant information delivered from • Any other required documents as indicated in the appropriate time to time. sections of this application (if applicable). • In this application, "You," "you," and "your" refers to all account holders, including individual, joint, trustees, and/or custodians. Each of the account holders agrees that any account holder has authority to act on behalf of this account. 1. Trust Information (Trust Nemo Enter AA trust name as eSenced by the trust docume BUTTERFLY TRUST For the Brmatit of Provide the tax reporting Ina Social Seamy or Tar ID Number Data of Truer MMOD Wit number for the trust. A SSN OR TIN decedent's SSN cannot be used as the tax State/Counuy of Organization reporting number. I Trust Address This is the legal address used for tax reporting. Street Address 6100 RED HOOK QUARTER B3 City state ZIP Code ST THOMAS VI 00802 Mailing Address This may be a.. Box, drop box, or do location. Same as residential address I> Default if no other information is indicated below. Mailing Address ZIP Cade Form continues on next page. L 1.791205.126 Page 1 of 9 002661701 • EFTA00299834  • 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 8. Do not make copies of Section 2 for additional individuals. Required. 2 Trustee only 0 Authority to appoint/remove trustees Check ALL that apply. O Trustee and grantor 0 Authority to revoke/amend the trust O Trustee is an entity If the trustee is an entity, check the box, enter full entity name as evidenced by the relevant formation document (e.g., trust document, partnership agreement corporate resolution), and a completed Fidelity Trustee Certification, Partnership Account Agreement, or Corporate Resolution 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 00 Ara Nano Middle Name Lift Name name as evidenced by a government-issued, RICHARD KAHN unexpired document (e.g., Entity Name driver's license, passport, permanent resident card). Date of Binh °Drat IFarsal Sooal Seamy or Taxpayer ID Number I Doyen* Phone Extension SSN OR 0 TIN Residential Address This is the legal address used for tax reporting. Street Addros 130 EAST 75ST APT 7E City State ZIP Coda NEW YORK NY 10021 Mailing Address This may be a. Box, drop box, or c/o location. O Same as residential address G Default if no other information is indicated below. Mailng Address 575 LEXINGTON AVE 4FL City !state ZIP Coda NEW YORK NY 10022 Citizenship U.S. citizen Indicate your 10. El citizenship status. O Foreign citizen Information in this box must be completed. 0 Permanent U.S. resident 0 Nonpermanent U.S. resident 0 Nonresident of U.S. County& Citizenship Check one and attach City, State/Proviice, and Country of Binh a copy of a valid and unexpired government ID showing number and photo. To claim non-U.S. tax status, 0' O Passport 0 Employment Authorization Document also complete and submit an IRS Form W-BEEN. O OHS Permanent Resident Card 0 Foreign National Identity Document Primary Trustee Information continues on next page. O. ► L 1.791205.126 Page 2 of 9 002661702 • EFTA00299835  2. Primary Trustee information, continued Income Source Industry regulations require us to ask for this information. ■ Check one and 1E1 Employed: ❑ Self-employed: provide information. Occupation Employer Leave blank if self.employed. FINANCIAL EXECUTIVE HBRK ASSOCIATES INC Employer Address 575 LEXINGTON AVE 4FL City State/Provnce ZIP/Postal Code county NEW YORK NY 10022 USA ❑ Retired: ❑ Not employed: Samoa of Income Pension, irmastments, spouse, etc. 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 confirma- tions and statements, or the transactions data contained therein, for your account(s) and any accounts you choose to As a person associated have on a consolidated statement for purposes of their compliance review. with a member firm, you are obligated to receive* Company Name consent from that firm. Fidelity has existing consent agreements Company Add with many firms for their employees to maintain accounts with City State/Prownce BP/Postal Code Country Fidelity and to deliver transactional data. If your firm is not one If you are, or an immediate family/household member is, a director, corporate officer, or 10% shareholder of a publicly held of them, Fidelity will company, or a COM:Oi person of a publicly traded company under SEC Rule 144, you must provide the information below. attempt to contact your Company Name Trading Symbol or custe firm's compliance office. 3. 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. If there are more than two individuals, make a copy of this Section 3 and have all trustees sign in Section 8. Required. ig Trustee only ❑ Grantor only ❑ Authority to appoint/remove trustees' Check ALL that apply. ❑ Trustee and grantor ❑ DECEASED Grantor> Prow& ONLY lull ❑ Authority to revoke/amend the trust• lege( name ❑ Trustee is an entity tf the trustee is an entity, check the box, enter full entity name as evidenced by the relevant formation document (e.g., trust document, partnership agreement corporate resolution), and a completed Fidelity Trustee Certification, Partnership Account Agreement, or Corporate Resolution 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 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 attached. Enter full first and last Name Middle Name Last Name name as evidenced by a government-issued, ERIKA KELLERHALS unexpired document (e.g., driver's license, passport, permanent resident card). Date of Borth MWcOnw Envoi Sooal Scanty or Taxpayer ID Nurrbor lesion ❑ SSN OR ❑ TIN P I I P L 1.791205.126 Page 3 of 9 002661703 ■ EFTA00299836  3. Additional Individual Information, continued • Residential Address This is the legal address used for tax reporting. Street Address ROYAL PALMS PROFESSIONAL BUILDING 62-3A & 62-3B ESTATE THOMAS City Steno ZIP Coda ST THOMAS VI 00802 Mailing Address Th's may be a.. Box, drop ha or do location. 0 Same as residential address f> Default if no other information is indicated below. Mailing Address 9053 ESTATE THOMAS SUITE 201 City state ZIP Coda ST THOMAS VI 00802 Citizenship Indicate your 2 U.S. citizen citizenship status. 0 Foreign citizen Information in this box must be completed. 0 Permanent U.S. resident 0 Nonpermanent U.S. resident 0 Nonresident of U.S. 1 Cooney of Coarenshp Country of Tax Residency Only appacablo to noneDu:Wu of the U.S. Check one and attach Ots StaterProvnce, and Country of Oath a copy of a valid and unexpired government ID showing number and photo. To claim non-U.S. tax status, illy' O Passport CI Employment Authorization Document also complete and submit an IRS Form W-8BEN. O DHS Permanent Resident Card 0 Foreign National Identity Document Income Source Required ONLY for trustees. Check one and I Employed: 0 Self-employed: provide information. Occupation Employer LoamMank dself•empforad Industry regulations require us to ask for ATTORNEY KELLERHALS FERGUSON KROBLIN PLLC this information. Employer Address 9053 ESTATE THOMAS SUITE 201 City State/Royale* /SP/Postal Code County ST THOMAS VI 00802 USA 0 Retired: 0 Not employed: Source of Income Pennon, investments. spouse, etc. Additional Individual Information continues on next page. L 1.791205.126 Page 4 of 9 0 0 2 6 61 7 0 4 • EFTA00299837  3. Additional Individual Information, continued • Associations Required ONLY for trustees. 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 confirma- tions and statements, or the transactions data contained therein, for your account(s) and any accounts you choose to As a person associated have on a consolidated statement for purposes of their compliance review. with a member firm, you are obligated to receive► Company Name consent from that firm. Fidelity has existing consent agreements Company Address with many firms for their employees to maintain accounts with ow Stato/Prownco 9P/Pond Coda Country Fidelity and to deliver transactional data. if your firm is not one If you are, or an immediate family/household member is, a director, corporate officer, or 10% shareholder of a publicly held of them, Fidelity will company, or a control person of a publicly traded company under SEC Rule 144, you must provide the information below. attempt to contact your Company Name Trading Symbol or CUSIP firm's compliance office. 4. Initial Funding This is a one-time contribution. Check all funding options that apply to this one-time transfer. 0 By check payable to Fidelity Brokerage Services LLC. (> This must be a check written by you, as third-party checks cannot be accepted. iii Transfer from another firm (> Include a completed Transfer of Assets form available at Fidelity.com/toa. Your name and ). 0 Transfer from your Fidelity nonretirement account: D If entire account value is transferred, the source account SSN must be will be dosed. Account features do not transfer and must be reestablished for the new account. identical on both accounts. 0 Brokerage Account Your Fucklity Brokerage Account Ntrnbor Amount Mist be avadablo as cash. OR 0 1 1 1 1 1 1 1 1 All Assets 0 Mutual Fund—Only Account Your Fidelity Mutual Fund-Only Account Number IFdolty Fund Name Dolor Amount $ OR 0 Transfer All Shares 5. Core Position Your core position ("Core Position") is where your money is held until you invest it. For your Core Position, you can choose either of the money market mutual fund options, listed below. If no choice is indicated, the default election is the Fidelity, Govemment Money Market Fund. You can change your election after your account is open, and there may be options other than those listed here that are available to you. For more information, contact Fidelity. Note that in certain circumstances, such as when Fidelity determines that you reside outside the United States, the Core Position will operate differently. Please refer to the Customer Agreement for further details. Fidelity taxable money market fund 7 Fidelity, Government Money Market Fund (SPAXX) D Default if no choice Is indicated. Fidelity Treasury Money Market Fund (FZFXX) Form continues on next page. It. Oa L 1.791205.126 Page 5 of 9 002661705 • EFTA00299838  • 6. Ongoing Funding Options Electronic Funds Transfer (En') 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.cornieft 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. avow*, Narno(s) Exactly as on Bank Account. Bank Routing/ABA Number Bank Name Chocking or Savings Accoint 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 Income and Dividends All income from securities (dividends, capital gains, or sale proceeds) is automatically deposited into our account. Dividends from mutual funds are reinvested in the originating fund. To change your distributions, call Fidelity or log in to 7. Account Features Additional account features are available for your new account. You may establish most of these online at Or, you may choose from the following: Checkwriting • Establish now—Checkwriting form is included with this application. ❑ Please send information to establish checkwriting in the future. ❑ Establish Fidelity BillPar. ❑ Order me a Fidelity° Visa° Gold Check 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. Electronic or Paper If you provided an email address in Section 2 and unless you indicate otherwise below, all materials will be sent to you Plprtronically To confirm electronic delivery, respond to the Electronic Delivery Agreement and Consent, which we will email to you. Choose to receive the following by U.S. mail: Rt Account statements ❑ Other documents (including shareholder reports and regular prospectus mailings) ❑ Trade confirmations and related prospectuses ▪ Tax forms and related disclosures Form continues on next page. L 1.791205.126 Page 6 of 9 002661706 ■ EFTA00299839  • 8. Account Owner Signatures and Dates Please be sure to read all the language included on the following pages, as well as sign, date, and return all pages of this application (1-9) to Fidelity. tf you are a U.S. person for tax purposes: • Certify under penalties of perjury that you • Certify under penalties of perjury that the • Certify 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 (or that you are waiting for a number to result of a failure to report all interest • You are submitting the applicable be issued to you). or dividends. Form W-8 with this form to certify your - The IRS has notified you that you are no foreign status and, if applicable, claim if the IRS has notified you that you are longer subject to backup withholding. tax treaty benefits. 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 contra 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 dosed if Fidelity cannot obtain and verify this information. Fidelity will not be responsible for any fosses 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 Fidelity Account Customer fications required to avoid backup withholding. Agreement, and that 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 on the next pages. i PRINT TRUSTEE NAME TRUSTEE SIGNATURE X TODAY'S DATE tamoo.rwr PRINT TRUSTEE NAME TRUSTEE SIGNATURE TODAY'S DATE IS004VVY 446304.17.0 Form continues on next page. ile• L 1.791205.126 Page 7 of 9 002661707 • EFTA00299840  • 9. Terms and Conditions By signing the previous section, you: • Hereby request Fidelity to open a Fidelity • Acknowledge that you have received and otherwise instructed, all dividend/interest Account in the name of the Trust listed as read either the full prospectus or summary income paid to the Transferor (Current on this application. prospectus for that fund. Asset Holder) of $100 or less will be • Affirm that you are at least 18 years old and • Consent to have only one copy of Fidelity systematically allocated to the Transferee of full legal age to enter into the agree- mutual fund shareholder documents, such (New Asset Holder) receiving the largest ments associated with this application in as prospectuses and shareholder reports share proportion of the account assets. If the your state of residence. ("Documents"), delivered to you and account is transferred evenly, the dividend/ any other investors sharing your address. interest income will be systematically • Represent and warrant that if you have not Your Documents will be householded allocated to the last transferee paid. completed the section titled Associations, Acknowledge that Fidelity will not be you are not associated with or employed indefinitely; however, you may revoke this consent at any time by contacting Fidelity liable for any loss, expense, or cost arising by a stodc exchange or a broker-dealer and at 800-343-3548, and you will begin receiv- out of your instructions, provided that it that you are not a control person or asso- institutes reasonable procedures to prevent ciate of a public company under SEC Rule ing multiple copies within 30 days. As Document for other investments become unauthorized transactions. 144 (such as a director, 10% shareholder, or a policy-making officer), or an immediate available in the future, these Documents • Certify that all information provided to us in family or household member of such may also be householded in accordance this form is true, accurate, and complete. a person. with this authorization or any notice or • Acknowledge that you will receive a • Affirm that you have received, read, agreement you received or entered into monthly account statement from Fidelity, with Fidelity or its service providers. unless there are no transactions in a partic- understood, and agree to be bound by the terms and conditions of the Customer • Understand that, upon issuers request ular month. In any case, you will receive a Agreement, this Application (including, in accordance with applicable rules and statement quarterly. if applicable, the Important Information regulations, Fidelity will supply your name • Understand that you will be receiving and regarding Electronic Funds Transfer (EFT) to issuers of any securities held in your reviewing separate account agreements and the Margin Agreement) and the account so you might receive any import- for usiaglidelity BillPar, and from PNC Schedule of Fees (which is incorporated ant information regarding them, unless you Bank, M., for using the Fidelity* Cash into the Agreement reference and notify Fidelity. Management Account Debit Card. legally forms a part of that document), as is • Acknowledge that if the prospectus you • Agree that any information you give to currently in effect and as may be amended received was the summary prospectus, you Fidelity on this application will be subject in the future. It shall inure to the benefit of have the right to request and review the full to verification, and you authorize Fidelity Fidelity's successors and assigns, whether prospectus before you invest in the fund. to obtain a credit report about you at any by merger, consolidation, or otherwise. • Agree to indemnify and hold Fidelity harm- time. Upon written request, Fidelity will Fidelity may transfer your account to its less from and against any and all losses, provide the name and address of the credit successors and assigns, and this Agreement liabilities, claims, and costs (including rea- reporting agency used. shall be binding upon your heirs, executors, sonable attorneys fees) that are in any way • Certify that this account is not a Pooled or administrators, successors, and assigns. connected with your instructions or with Omnibus Account A Pooled or Omnibus • Adcnowledge that you have received the any telephone, Internet, or other electronic Account is a single account that pools description of the Core Position in the request for redemption so long as Fidelity the holdings of more than one beneficial Customer Agreement, including Fidelity's transmits the redemption proceeds to the owner, whose identities are not disclosed right to change the options available as bank account identified above. You further to Fidelity, in which the beneficial owners Core Positions, and consent to having free agree that the indemnifications in this have the ability to effect transactions, and credit balances held or invested in the Core bullet are in addition to, and do not limit, for which subaccounting is performed by the Position indicated above. any rights that Fidelity may have under any Omnibus Account holder or a third party. • Understand that your Core Position is a other agreement with you. If requesting EFT: money market fund, and that you could • Acknowledge that Fidelity will not be liable lose money by investing in a money for any loss, cost, or expense arising out of • Acknowledge that you have read and agree to the Important Information about market fund. Although the fund seeks to your instructions, provided that it institutes Electronic Fund Transfer document. preserve the value of your investment reasonable procedures to prevent unautho- at $1.00 per share, it cannot guarantee rized transactions. • Authorize Fidelity, upon receiving it will do so. An investment in the fund • Hereby constitute and appoint Fidelity your instructions from you, to make payments is not insured or guaranteed by the of amounts representing redemptions by true and lawful attorney to surrender for you or distributions payable to you by Federal Deposit Insurance Corporation redemption any and all shares held in the or any other government agency. Fidelity above-indicated accounts with full power of initiating credit or debit entries to the bank Investments and its affiliates, the fund's account identified in Section 6 ("Bank"), substitution in the premises. as indicated on the attached "voided" sponsor, have no legal obligation to pro- • Acknowledge that Fidelity reserves the vide financial support to money market chedc, deposit slip, or bank statement. You right to cease to act as agent in connection authorize and request the Bank to accept funds and you should not expect that the with the above appointment after provision sponsor will provide financial support to such entries from Fidelity, and to credit or of notice to the address noted on this form. debit, as indicated, your account at the the fund at any time. • Certify and agree that the certifications, Bank in accordance with these entries. • Understand that Fidelity's govemment and authorizations, and appointments in this U.S. Treasury money market funds will not • Acknowledge that this authorization may document will continue until Fidelity only be revoked by providing written notice impose a fee upon the sale of your shares, receives actual written notice of any change of revocation to Fidelity, in such time and nor temporarily suspend your ability to sell thereof. shares if the fund's weekly liquid assets fall manner as afford Fidelity and the Bank a below 30% of its total assets because of • Agree to be responsible for any and all fees reasonable opportunity to act upon it. market conditions or other factors. and charges that apply to the account • Understand that Fidelity may purge unused • Understand that it is your responsibility to • Upon transfer of assets due to any life EFT instructions from your account on a read the prospectus of the Core Position. event (death, divorce, etc.), and unless periodic basis without notice to you. Form continues on next page. 1.791205.126 L Page 8 of 9 002661708 ■ EFTA00299841 9. Terms and Conditions, continued ■ • Understand that Fidelity may terminate the protection, may require the written consent terms and conditions of all other account EFT instructions from your account at any of any or all Trustees before acting on the agreements applicable to this account. The time in Os sole discretion. instructions of any Trustee. Trustees, jointly and severally, indemnify Trustee Certification of investment Power • Certify that there are no Trustees of the Fidelity and hold Fidelity harmless from any Trust other than those listed above. Should claim, loss, expense, or other liability for • Fidelity has the authority to accept instructions relative to the Trust account only one person execute this agreement, acting pursuant to the instructions given by identified herein from those individuals it shall be a representation that the signer the Trustees. The Trustees further agree not is the sole Trustee. Where ap icable, to give any instructions for which they are listed as Trustees in Sections 2 and 3. They may execute any documents on behalf of plural references in this certi cation not in full compliance with the Trust. The the Trust that Fidelity may require. shall be deemed singular. The Trustees Trustees agree to inform Fidelity, in writing, represent that they have the power under of any change in the composition of the • Certify that Fidelity is authorized to follow Trustees, or any other event that could alter the Trust Agreement and applicable law to the instructions of any Trustee and to the certifications made above. deliver funds, securities, or any other enter into the transactions and issue the assets in the account to any Trustee instructions that they make on behalf of the • If induded, the pages of the Trust Trust account with Fidelity. The Trustees document are true copies of the valid legal on any Trustee's instructions, including delivering assets to a Trustee personally. understand that all such transactions document currently in effect. Fidelity, in its sole discretion and for its sole and instructions will be govemed by the Use postage-paid envelope, drop off at a Fidelity Did you sign the form and attach a check or any necessary documents? investor Center, OR deliver to: Please return pages 1-9 and any necessary attachments. You will receive Regular mail Overnight mail a "New Account Profile" confirming that your account(s) is opened. Fidelity Investments Fidelity Investments Questions? Go to or call 800-343-3548. M. 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 LW, Member NYSE, SIPC. Alf trademarks and service marks used herein are the property of their respective owners. 446304.17.0 (03/18) L 1.791205.126 Page 9 of 9 002661709 ■ EFTA00299842 Of 1401W Questions? G•. or call 800-343-3548. ■ ()Trusted Contact Authorization Form Your physical and financial well-being are among our top priorities. Let us help you safeguard both. Use this form to designate a primary and alternate trusted contact, that is 18 years or older, for your Fidelity account(s). Do NOT use this form for charitable giving accounts or workplace retirement plans, such as a 401(k). 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. Helpful to Know • To prepare yourself and your trusted contact(s) for success,