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Date Created: 12/21/15
Standing Letter of Instruction 1 CUSTOMER INFORMATION Name of Owner (or Trust/Business/Custodian) Co-Owner (or Trustee) FROM Fidelity Account Number* – *A separate Standing Letter of Instruction form must be completed for each account from which money will be transferred out. 2 MONEY MOVEMENT AUTHORIZATION TO ANOTHER FIDELITY ACCOUNT I (We), the account owner(s) or trustee(s), authorize Fidelity Investments to accept my (our) verbal or written instructions and, based solely on the instruction of one account owner, to transfer assets from the above account to any account or accounts listed below. TO Fidelity Account Number(s) – – – – – – 3 MONEY MOVEMENT AUTHORIZATION TO A BANK ACCOUNT I (We), the account owner(s), authorize Fidelity Investments to accept my (our) verbal or written instructions, and based solely on the instruction of one account owner to transfer assets from the above account to the account or accounts listed below. If providing more than 2 bank accounts, please make a photocopy of this page. Bank Wire Routing Number Bank Wire Routing Number Bank Account Number Bank Account Number Name of Bank Name of Bank Name(s) EXACTLY as they appear on Bank Account Name(s) EXACTLY as they appear on Bank Account “For Further Credit” Name: If required by bank “For Further Credit” Name: If required by bank Additional Information Additional Information U.S. dollars only. This form is not to be used for foreign currency money movement. 1.835493.105 017370301 4 AUTHORIZATION AND INDEMNIFICATION I (We), the undersigned, hereby authorize National Financial Services LLC, Fidelity Brokerage Services LLC, Fidelity Management Trust Company, Fidelity Service Company, Fidelity Distributors Corporation, and their affiliates, control persons, officers, directors, successors, assigns, and employees (“Fidelity”) to act on the instructions denoted above on the account indicated, at such time and in such manner based upon instructions received either in person or through a verified telephone communication from me (us). I (We) agree to fully indemnify Fidelity, hold Fidelity harmless from, and pay Fidelity promptly upon demand for any and all losses, liabilities, claims, and costs (including reasonable attorneys’ fees) resulting from transactions made in accordance with the instructions stated above that are received and accepted by Fidelity from me (us). I (We) understand that this standing letter of instruc- tion and authorization will remain in full force and effect until such time as Fidelity has received written notice from me (us) of any change to, or termination of, this authorization while this authorization is in effect and as long as such notice is received in such time and in such manner as to afford Fidelity reasonable opportunity to act on it. Fidelity may terminate this standing letter of instruction at any time, in its sole discretion. This indemnification is in addition to and in no way restricts any rights that may exist at law or under any other agreement(s) between me (us) and Fidelity as they currently exist and as they may be modified in the future. This authorization and indemnification will be binding upon my (our) successors, assignees, heirs, executors, and administrators. For Trust Accounts By signing below as trustee, I certify that I have the power and authority under the trust agreement and applicable law to enter into all transactions, including purchases, sales, and exchanges and redemptions of mutual funds, and to deliver any documents necessary to open and maintain accounts on behalf of the trust. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (OR TRUST/BUSINESS/CUSTODIAN) DATE (OR TRUSTEE) DATE X X Signatures of all account owners are required. SIGNATURE GUARANTEE STAMP SIGNATURE GUARANTEE STAMP A signature guarantee is designed to protect you and Fidelity from fraud. You should be able to obtain a signature guarantee from a bank, broker, broker-dealer, credit union (if authorized under state law), securities exchange or association, clearing agency, or savings associa- tion. A notary public cannot provide a signature guarantee, and a notarization cannot be accepted in lieu of a signature guarantee. 442696.7.0 Fidelity Distributors Corporation SLOI-FRM-0211 ATTN: Client Services, P.O. Box 770001 1.835493.105 Cincinnati, OH 45277-0045 Fidelity Brokerage Services LLC, Member NYSE, SIPC Fidelity Investments is a registered service mark of FMR LLC. 1.835493.105 017370302
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