Fidelity Advisor SIMPLE IRA Contribution Allocation and ...

Fidelity Advisor

SIMPLE IRA Contribution Allocation and Exchange

Use this form to establish or revise the manner in which your Fidelity Advisor SIMPLE IRA contributions or your current account balances are invested.

Type on screen or fill in using CAPITAL letters and black ink.

1. Account Information

Account Owner First Name

M.I.

Account Owner Last Name

Account Number

Date of Birth MM DD YYYY

SSN required

You must provide an u Mobile Phone Number Used as your primary phone Email Address* email address and mobile phone number to be used to verify and/or authorize

transactions. *See Electronic Delivery section for more details.

2. Electronic Delivery

IMPORTANT: By signing this form, you are consenting to receive all account-related communications electronically. You agree that Fidelity may use your email and/or mobile number to message, call, or text you for this purpose. Message and data rates apply; frequency may vary. To manage your delivery preferences, log into accounts. and select the eDelivery settings in your Overview section. To confirm your consent, please respond to the electronic message which Fidelity will email to you.

Note:

?Your delivery preferences are applied across all eligible Fidelity accounts owned by you based upon your most recent election. If you have already consented to electronic delivery, your election will not change.

?The email address provided should not be your Authorized agent/ Representative's email address.

?This email address will replace any existing email address already on our system.

3. Contribution Allocation

Indicate allocation changes to future SIMPLE IRA Elective Deferrals (if any) and Employer Matching or Employer Nonelective

Contributions.

Percentages must be whole numbers. If total does not equal 100%, the percentage of the first fund selected will be adjusted to the extent necessary to bring the

total to 100%.

To allocate into more than 10 funds, attach a separate sheet with additional instructions.

Fund Number Fund Number Fund Number Fund Number Fund Number

Percentage

%

Percentage

%

Percentage

%

Percentage

%

Percentage

%

Fund Number Fund Number Fund Number Fund Number Fund Number

Percentage

%

Percentage

%

Percentage

%

Percentage

%

Percentage

%

Total must equal 100%

0%

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4. Exchange Instructions

To exchange among more than five funds,

attach a separate sheet with additional allocation instructions.

You may also perform this transaction at

accounts..

Reallocate your existing balances by exchanging monies from one fund to another fund. Exchanges will be made into the same class of shares of an identically registered Fidelity Advisor Fund. Refer to the prospectus for any sales charges or short-term trading fees that may apply due to this transaction.

From: Fund #

To: Fund #

Dollar Amount

$

Number of Shares

OR

.

.

Percentage

OR %

From: Fund #

To: Fund #

Dollar Amount

$

Number of Shares

OR

.

.

Percentage

OR %

From: Fund #

To: Fund #

Dollar Amount

$

Number of Shares

OR

.

.

Percentage

OR %

From: Fund #

To: Fund #

Dollar Amount

$

Number of Shares

OR

.

.

Percentage

OR %

From: Fund #

To: Fund #

Dollar Amount

$

Number of Shares

OR

.

.

Percentage

OR %

5. Signature and Date Form cannot be processed without signature and date.

?I have received and read the prospectus(es) for the fund(s) into which I am making my contribution(s), and I understand that it is my responsibility to read the prospectus(es) for any mutual fund(s) into which I exchange.

?I authorize and request Fidelity Investments Institutional Operations Company LLC (FIIOC), as agent for Fidelity Management Trust Company (FMTC) (or their agents, affiliates, or successor custodians, as applicable), to make the above changes I have indicated. I hereby

Print Shareholder Name First, M.I., Last

direct Fidelity Management Trust Company (FMTC) (or its successor(s)), Custodian of the Fidelity Advisor SIMPLE IRA, to establish a new fund position, as applicable, and to process contribution(s) and investment transaction(s), as set forth above, for the Fidelity Advisor SIMPLE IRA identified above. I understand that my Fidelity Advisor SIMPLE IRA will be invested in the class of shares that I previously selected on the Fidelity Advisor SIMPLE IRA Application.

Shareholder or Authorized Signer Signature

Date MM - DD - YYYY

SIGN

Did you sign the form, and attach any necessary documents? Send the form and any necessary documents to Fidelity.

UPLOAD THROUGH WEB

FAX

MAIL

Log into Accounts.

888-321-7349

Instructions for Shareholders:

1.Under "Manage Accounts, Other Services," go to the "Upload Documents" link.

2.Follow instructions on the web portal and click "UPLOAD DOCUMENTS."

Instructions for Financial Representatives:

1.Under "Quick Links" on the landing page, go to the "Upload Documents" link.

2.Follow instructions on the web portal and click "UPLOAD DOCUMENTS."

Fidelity Investments Institutional Operations Company LLC (FIIOC)

Regular: P.O. Box 770002, Cincinnati, OH 45277-0082 Overnight: 100 Crosby Parkway, KC1G, Covington, KY 41015

IMPORTANT: If an original signature guarantee or notary is required, this form must be mailed.

Questions? For help completing this form, call 800-522-7297 (Financial Representatives) or 877-208-0098 (Shareholders), or visit accounts..

The trademarks and service marks appearing herein are the property of FMR LLC.

Fidelity Investments Institutional Operations Company LLC

925442.2.0

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