Questions? Go to Fidelity.com or call 800-343-3548.

Fiduciary Certification—IRAUse this form to add a guardian or conservator (Fiduciary) to an existing IRA account. Do NOT use this form for a Fidelity Retirement Plan or a Fidelity managed account. 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• Submit a certified copy of the court appointment of

guardianship or conservatorship of the ward’s estate, and any supporting documents required, dated within the last 90 days, along with this form.

• In cases where more than one person or entity has been appointed to act in a fiduciary capacity, each named individual must complete a separate Fiduciary Certification — IRA form and the signature required in Section 3 must be notarized.

• The Fiduciary will be added as an Authorized Individual on the account and online access will be removed from the ward.

• If the existing account has options trading or checkwriting, new forms must be completed to maintain the features on the account. Visit Fidelity.com to obtain the necessary forms.

1. Account Owner (Ward)Account Number Account Number Account Number

Social Security Number Name of Ward

2. Fiduciary Information

You are appointed:

Guardian or Co-Guardian

Conservator or Co-Conservator

First Name Middle Name Last Name

Date of Birth MM DD YYYY

Entity Name

Social Security or Taxpayer ID Number Daytime Phone Extension

Residential Address This is your 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 indicated below.

Mailing Address

City State ZIP Code

Provide the ward’s Fidelity

account number(s).

Please ensure that the court appointment

covers the ward’s estate.

Enter full first and last name as evidenced by a government-issued, unexpired document

(e.g., driver’s license, passport, permanent resident card).

If the Fiduciary is an entity, enter the full entity name as

evidenced by the relevant formation document (e.g.,

trust document, partnership agreement, articles of

incorporation). Additional Fidelity forms and supporting documentation are required.

The ward’s mailing address will be

updated to the address provided here.

Page 1 of 4 0321003011.9858071.104

Fiduciary Information continues on next page.

Citizenship

U.S. citizen

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 Only applicable to nonresidents of the U.S.

City, State/Province, and Country of Birth

Passport

DHS Permanent Resident Card

Employment Authorization Document

Foreign National Identity Document

Income Source Industry regulations require us to ask for this information.

Employed Self-employed Occupation Employer Leave blank if self-employed.

Employer Address

City State/Province ZIP/Postal Code Country

Retired Not employed Source of Income Pension, investments, 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 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.

Check one and provide information.

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.

Page 2 of 4 0321003021.9858071.104

2. Fiduciary Information, continued

Form continues on next page.

3. Signature and Date Notary only required if adding more than one Fiduciary.

By signing below, you agree:

• Not to exercise any powers granted to you by the accompanying court appointment if you know or have reason to know that the court appointment has been partially or completely revoked, terminated, or suspended or is no longer valid due to any reason whatsoever; and

• Not to give, transmit, convey, or issue any instruction concerning the above referenced account that you know, or believe is not authorized by or otherwise not in compliance with, in violation of the accompanying court appointment; and

• To indemnify Fidelity (jointly and severally) from and hold Fidelity harmless for any and all losses, liabilities, claims, and costs (including reasonable attorneys’ fees) resulting from transactions made in accordance with your instructions; and

• That this Affidavit will remain in full force and effect until such reasonable period of time after Fidelity receives written notice of its termination or significant alteration as would allow Fidelity to take the necessary steps in response to such notice.

• Affirm that you have read, and that you understand and agree to be bound by, the provisions of this form as well as the terms and conditions set forth in the Fidelity Account Customer Agreement (including those terms to which the account owner is bound) and any applicable state notices.

• Represent and warrant that if you have not completed the section titled Associations, you are not employed by nor associated with a broker-dealer, stock exchange, exchange member firm, FINRA, a municipal securities dealer, or any other financial institution, nor are you the spouse or immediate family member residing in the same household of such a person.

• Represent and warrant that if you have not completed the section titled Affiliations, none of you, your spouse, nor any of your relatives living in your home are a control person or affiliate of a public company under SEC Rule 144.

If signing as a Co-Fiduciary, you warrant, represent, and affirm that, to the best of your knowledge, you:

• Are authorized to act severally or individually and that Fidelity (as defined below) may follow any of your instructions independent of all other executors, guardians, or conservators, including the delivery of assets to an executor, guardian, or conservator personally.

• Understand that in the event of conflicting instructions given by fiduciaries, Fidelity may restrict the account pending receipt of satisfactory joint written instructions.

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 individu-als 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.

PRINT FIDUCIARY NAME

FIDUCIARY SIGNATURE DATE MM/DD/YYYY

SIG

N X XImportant 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 Acknowledgement of Notary Public Must be a U.S. Notary. Foreign notary or consular seals may NOT be substituted.

State of , in the County of , subscribed and sworn to before me by the

above-named Co-Fiduciary who is personally known to me or who has produced as identification, that the

foregoing statements were true and accurate and made of his or her own free act and deed, on / / .

PRINT NOTARY NAME

NOTARY SIGNATURE DATE MM/DD/YYYY

SIG

N X XMy commission expires on / / .

NOTARY SEAL / STAMP

Page 3 of 4 0321003031.9858071.104

Form ends here.

On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 692401.5.0 (02/20)

Page 4 of 4 0321003041.9858071.104

Did you sign the form and attach any necessary documents? Send the ENTIRE form and any attachments to Fidelity Investments. Questions? Go to Fidelity.com or call 800-343-3548.

Regular mail Fidelity Investments PO Box 770001 Cincinnati, OH 45277-0039

Overnight mail Fidelity Investments Account Reregistration Services 100 Crosby Parkway KC1C Covington, KY 41015