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New Fidelity Account?--Inherited IRA for a Non-Spouse Individual

Use this application if you are a non-spouse beneficiary of an IRA or a qualified retirement plan and the original account owner is deceased and you need to open an Inherited IRA or Inherited Roth IRA. Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more room for information or signatures, use a copy of the relevant page.

Important to Understand

By signing this application, you acknowledge that:

Helpful to Know

? Fidelity Brokerage Services LLC ("FBS") will perform

Regarding this account:

brokerage and administrative services.

? If the deceased was over 72* and had not withdrawn his

? National Financial Services LLC ("NFS") will maintain

or her total required minimum distribution (RMD) in the

the assets in a brokerage account and provide

year of death, see Section 7.

administrative services.

? Use this form if you are a non-spouse individual over the

? Fidelity Management Trust Company ("FMTC") will act as age of 18.

IRA Custodian.

? Please use the Fidelity Inherited IRA for Minors/Non-

? FBS, NFS, and FMTC are together referred to herein as

Individuals application if you are inheriting from the

"Fidelity."

original owner and:

? Important documents related to your account include the Fidelity IRA Custodial Agreement and Disclosure Statement or Fidelity Roth IRA Custodial Agreement and Disclosure Statement and Fidelity Brokerage Retirement Account

? Y ou are a minor or incapacitated person that is named as the beneficiary.

? Your intent is to open a Trust Inherited IRA.

Customer Agreement ("Customer Agreement"), and other ? T he deceased IRA owner's or a deceased beneficiary's

relevant information delivered from time to time.

estate is inheriting.

? Uninvested money in your account is held in your Core

? Y ou represent an entity like a charity, university, or other

Position ("Core Position") until you direct otherwise. Your

educational organization.

Core Position will be the Fidelity? Government Money To learn more about these options, visit . Market Fund, a money market mutual fund. Other Core

Position options may be available after you open your

account. Please note that in certain circumstances, such

as if Fidelity determines you reside outside the United

States, the Core Position will operate differently. Please

refer to the Customer Agreement for further details.

1. Deceased IRA Owner's Information Include a copy of deceased's death certificate and a

state inheritance tax waiver, if required by the deceased's state of residence.

You are known as a successor beneficiary if you are inheriting an IRA after the original

beneficiary's death.

Who are you directly inheriting this IRA from? Tell us by completing the fields below.

First Name

Middle Name

Last Name

Social Security Number

Date of Birth MM DD YYYY

Date of Death MM DD YYYY

Only complete the below section if you are the beneficiary of an inherited IRA. Do not complete this section if a spouse originally inherited the account and moved to an IRA in their name. Please call Inheritor Services at 800-544-0003 with any questions.

Original Owner's First Name

Middle Name

Original Owner's Last Name

Social Security Number

Date of Birth MM DD YYYY

Date of Death MM DD YYYY

Account owner must sign and date at the end of section 8. Form continues on next page.

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2. Selection of Type of Account

Indicate the type of account you plan to establish. For more information about options available to you as an owner inheriting retirement assets, go to .

Establish a New Account

Inherited IRA Inherited Roth IRA

3. Your Information

Enter full name as evidenced by a government-issued, unexpired document (e.g., driver's license, passport, permanent

resident card).

First Name

Middle Name

Date of Birth MM DD YYYY

Email

Social Security or Taxpayer ID Number

Daytime Phone

Last Name Extension

Residential Address (where you live) This is your legal address used for tax reporting.

Street Address

City

State

ZIP

Mailing Address May be a P.O. box, drop box, or c/o location

Same as legal/residential address Default if no other information indicated below.

Mailing Address

City

State

ZIP

Citizenship

Indicate your citizenship status.

U.S. citizen

Foreign citizen Information in this box must be completed.

Permanent U.S. resident

Country of Citizenship

Non-permanent U.S. resident

Nonresident of U.S.

Country of Tax Residency Only applicable to nonresidents of the U.S.

Check one and attach a copy of a valid and

unexpired government ID

showing number and photo. To claim non-U.S. tax status, also complete and submit an

IRS Form W-8BEN.

City, State/Province, and Country of Birth

Passport DHS Permanent Resident Card

Employment Authorization Document Foreign National Identity Document

Account owner must sign and date at the end of section 8. Your Information continues on next page.

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3. Your Information, continued

Income Source

Check one and provide information. Industry regulations require us to ask for

this information.

Employed:

Occupation

Self-employed:

Employer Address

City

State/Province

Employer Leave blank if self-employed.

ZIP/Postal Code

Country

Retired:

Not employed:

Source of Income Pension, investments, spouse, etc.

Associations

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.

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 employment 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

4. Funding Method

Check all funding options that apply. Transfer Inherited Assets

T ransfer from deceased's Fidelity IRA: All shares will be transferred in kind. Account number indicated below can be for a Traditional or Roth IRA and will be transferred to accounts selected in Section 2.

Fidelity IRA Account Number

Fidelity IRA Account Number

Transfer an Inherited IRA from another firm Include a completed Transfer of Assets form and include a copy of the deceased's account statement. Transfer rules vary among firms. Check with the firm's guidelines to ensure that the original account owner's assets are eligible for transfer into a Fidelity Inherited IRA.

Account owner must sign and date at the end of section 8. Funding Method continues on next page.

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4. Funding Method, continued

Rollover Roll over from an employer-sponsored account. If plan is recordkept at Fidelity, contact us at 800-605-4015 for next steps. Please indicate Name of Employer below:

Name of Employer

If Rollover is from a plan not at Fidelity, you will need to contact the plan administrator by calling the toll-free number on the statement of the account you have inherited.

Name of Employer's Plan

Recordkeeper Name Where your assets are held

Recordkeeper Phone

Address

City

State

ZIP

Plan ID/Account Number

Approximate Rollover Amount

$

.

Send a letter of acknowledgement to the Plan Administrator to the address provided above on your behalf. OR

Enclosed is a check with this application, or the plan has been contacted and will be mailing Fidelity a check. Make check payable and send to: FMTC, FBO (your name), Direct Rollover, P.O. Box 770001, Cincinnati, OH, 45277-0037.

5. Account Features

Optional. Additional features may be available for your account(s). Call Fidelity or go to .

Automatic Withdrawals You can create a schedule of Automatic Withdrawals from your account to help satisfy your RMD or establish an income stream. Go to autowithd for more information.

Document Delivery

If you provided an email address in Section 3 and unless you indicate otherwise below, all materials will be sent to you electronically. To confirm electronic delivery, respond to the Electronic Delivery Agreement and Consent, which we will email to you. To choose delivery by U.S. mail, check one or more boxes below.

Check only those items you do NOT

want to receive electronically.

Account statements Trade confirmations and related prospectuses Tax forms and related disclosures

Other documents (including shareholder reports and regular prospectus mailings)

Account owner must sign and date at the end of section 8. Form continues on next page.

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6. Beneficiaries

You may want to review this document with a tax, financial, or legal advisor. Leaving this section blank will indicate that no beneficiary is named by you for this account and that upon your death, payment will be made according to the rules of succession as outlined in the applicable Custodial Agreement. You can add or change beneficiaries any time at beneficiary.

Primary Beneficiaries

For each beneficiary you list by name,

check a beneficiary type and provide all information.

If you outlive the beneficiary and

you want that beneficiary's share to go to each of his or her descendants by right of representation, check

"per stirpes."

Spouse

Name If naming spouse as a beneficiary, do so here.

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Date of Birth MM DD YYYY

Other Entity

Name

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Other Entity

Date of Birth MM DD YYYY

Share Percentage

%

Per stirpes

Share Percentage

%

Per stirpes

Name

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Other Entity

Date of Birth MM DD YYYY

Share Percentage

%

Per stirpes

Contingent Beneficiaries

Total must add up to 100%.

0%

Contingent beneficiaries receive assets only if no primary beneficiary

survives you.

Do NOT list any primary beneficiaries here.

Spouse

Name If naming spouse as a beneficiary, do so here.

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Date of Birth MM DD YYYY

Other Entity

Name

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Other Entity

Date of Birth MM DD YYYY

Share Percentage

%

Per stirpes

Share Percentage

%

Per stirpes

Name

Non-Spouse

Trust

Social Security or Taxpayer ID Number

Other Entity

Date of Birth MM DD YYYY

Share Percentage

%

Per stirpes

Total must add up to 100%.

0%

Account owner must sign and date at the end of section 8. Form continues on next page.

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7. Required Minimum Distribution (RMD) for Deceased Age 72* or Older

Was the deceased over 72* and had not yet withdrawn his or her total RMD in the year he or she died? If the answer is "YES," please complete this entire section.

If not, please skip this entire section and move on to section 8.

7a. Deceased's RMD Amount

Only complete sections 7a, 7b, and

7c if the deceased was older than 72* at time of death, and had not completed an RMD in the year that

he or she died.

Call Fidelity Inheritor Services at 800-544-0003 if you need the RMD

calculated.

If you answered "YES" to the question above, you, as the beneficiary, must withdraw the appropriate amount by December 31 in the year of death. The distribution amount must be based on the deceased's RMD schedule but reported under your tax ID number.

To comply with IRS regulations, Fidelity requires the remaining year-of-death RMD, if applicable, to be taken from an inherited IRA. Please note: If you wish to withdraw an amount other than the deceased's RMD, please complete the enclosed Fidelity IRA One-Time Withdrawal form. If you wish to establish periodic withdrawals on this newly established inherited IRA, please complete the Fidelity Inherited IRA Automatic Withdrawal Service form or go online at autowithd.

Request for deceased's RMD

Amount (required if box is checked)

$

.

If there are multiple beneficiaries inheriting the IRA, please provide ONLY the amount you wish distributed from your inherited IRA.

The RMD will be taken from the cash position. If there is not enough cash available, please complete the following in the order in which to liquidate a fund or individual security to meet the RMD amount. Please note that if multiple securities are listed, trades may be placed over multiple days. If no securities are provided, your requested RMD will be withdrawn proportionately from all eligible money market and mutual fund positions.

1. Security/Fund Name

2. Security/Fund Name

7b. Distributions Method Only applies if you have listed an amount in section 7a.

Check one and provide any required

information.

Directly deposited to your Fidelity nonretirement account:

Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol Mutual Fund Accounts Only

Brokerage accounts will be deposited into the Core Position.

Check mailed to the address of record Default if no choice indicated or if we are unable to process your choice.

7c. Tax Withholding Only applies if you have listed an amount in section 7a.

RMDs from a non-Roth IRA are subject to federal and, where applicable, state income tax withholding unless you elect not to have withholding apply below (if you are a U.S. citizen or other U.S. person, including a resident alien individual). If you do not elect out of withholding, federal income tax will be withheld at a rate of 10% from your total IRA distribution amount, unless you indicate a higher percentage below. If there are nondeductible contributions in your IRA, this may result in excess withholding from your distribution. If you elect not to have withholding apply to your distribution or if you do not have enough federal income tax withheld from your distribution, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. See "State Tax Withholding information -- IRA Withdrawals" at the end of this form.

Federal

State

Do NOT withhold federal taxes.

Do NOT withhold state taxes unless required by law.

Withhold federal taxes at the rate of:

Percentage

Minimum 10%, maximum 99%. Whole numbers; no dollar amounts. Note

% that if there is federal withholding,

certain states require that there also be state withholding.

Withhold state taxes at the applicable rate.

Withhold state taxes at the rate of:

Percentage

Maximum 99%. Whole numbers; no dollar amounts.

%

Account owner must sign and date at the end of section 8. Form continues on next page.

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8. Account Owner Signature and Date

Please be sure to read all the language included below and on the next page, as well as sign, date, and return all pages of this application (1?8) to Fidelity.

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.

You acknowledge that this account is governed by a predispute arbitration clause, which appears on the last page of the Fidelity Brokerage Retirement Customer Account Agreement, and that you have read the predispute arbitration clause.

By signing below, you acknowledge that you have read, understood, and agree to be bound by the provisions of this application, including the Terms and Conditions for This Account below and on the next page.

PRINT OWNER NAME

SIGN

OWNER SIGNATURE

X

TODAY'S DATE MM/DD/YYYY

X

D AT E

9. Terms and Conditions for This Account

By signing the previous section, you:

? Adopt the Fidelity IRA or Fidelity Roth IRA selected in Section 1 and appoint FMTC (or its successor) as Custodian, and FBS and NFS to perform administrative services pursuant to the terms of the Fidelity IRA or Roth IRA Custodial Agreement.

? Acknowledge that you received the Customer Agreement, the Fidelity IRA Custodial Agreement and Disclosure Statement, and the Fidelity Roth IRA Custodial Agreement and Disclosure Statement, that you have read and understand both the Customer Agreement and the applicable Custodial Agreement(s) that apply to the account(s) you are opening with this application, and that you agree to all terms and conditions on this application and in the above agreements, as these agreements may be amended from time to time.

? Acknowledge that acceptance of your application will be indicated by a Letter of Acceptance signed by, or on behalf of, Fidelity or its agent, and delivered upon the Custodian's receipt of the initial contribution.

? Acknowledge that FMTC's acceptance of ? Agree that to the extent that inherited

its appointment as Custodian is effective

employer-sponsored plan assets are being

upon proper completion and signature

directly rolled to an IRA or Inherited IRA,

of the application, and contingent upon

you understand that it is your responsibility

timely delivery of this application, as signed to ensure that only eligible assets are rolled

and properly completed, to the Custodian, and all required minimum distributions

notwithstanding what is stated in Article

are satisfied.

8, Section 27, of the Fidelity IRA Custodial Agreement and Article 9, Section 26, of the Fidelity Roth IRA Custodial Agreement, as appropriate.

? Agree that upon transfer of assets due to any life event (divorce, death, etc.), and unless otherwise instructed, all residual income paid to the account and any

? Understand Fidelity may charge an annual fractional shares will be systematically

maintenance fee and/or liquidation fee

allocated to the Transferee (New Asset

and this fee may be separately billed or

Holder) receiving the largest share

collected by liquidating sufficient securities proportion of the account assets. If the

from your account. Fidelity may change the account is transferred evenly, or at different

fee schedule from time to time, as provided intervals, the income and/or fractional

in the Fidelity IRA Custodial Agreement.

shares will be systematically allocated to

? Agree to indemnify the Custodian (its

the last transferee paid.

agents, affiliates, successors, and employ- ? Affirm that you have received and read

ees) from any and all liability in the event

the Schedule of Fees, that you understand

that you fail to meet any IRS requirements this schedule may change from time to

concerning your IRA(s).

time, and that you agree to be responsible

? Acknowledge that payment to beneficiaries will be made according to the rules

for those fees and charges that apply to your account.

of succession described in the applicable

Custodial Agreement.

Account owner must sign and date at the end of section 8. Form continues on next page.

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9. Terms and Conditions for This Account, continued

? Acknowledge that you understand prohibi- or any other government agency. Fidelity ? Understand that it is your responsibility to

tions on your inherited IRA, including, but

Investments and its affiliates, the fund's

read the prospectus for any security pur-

not limited to, the receipt of annual or roll- sponsor, have no legal obligation to pro- chased for your account or into which your

over contribution amounts, any attempt to vide financial support to money market

holdings are exchanged, including the

roll over the inherited IRA to another type funds and you should not expect that the Core Position.

of IRA or another inherited IRA, and/or any attempt to convert the inherited IRA to an inherited Roth IRA.

sponsor will provide financial support to the fund at any time.

? Understand that Fidelity's government and

? Acknowledge that Fidelity will not be liable for any loss, cost, or expense arising out of your instructions, provided that it institutes

? C ertify that all information provided in this U.S. Treasury money market funds will not reasonable procedures to prevent unautho-

application is true, accurate, and complete. impose a fee upon the sale of your shares, rized transactions.

? A ffirm that you are at least 18 years old and of full legal age to enter into the agreements associated with this application in your state of residence.

nor temporarily suspend your ability to sell shares if the fund's weekly liquid assets fall below 30% of its total assets because of market conditions or other factors.

? Hereby constitute and appoint Fidelity your true and lawful attorney to surrender for redemption any and all shares held in the above-indicated accounts with full power of

? R epresent and warrant that if you have not ? Acknowledge that you have received the

substitution in the premises.

completed the section titled Associations,

description of the Core Account in the

? Acknowledge that Fidelity reserves the

you are not employed by nor associated

Customer Agreement, including Fidelity's

right to cease to act as agent in connection

with a broker-dealer, stock exchange,

right to change the options available as

with the above appointment after provision

exchange member firm, FINRA, a munici-

core positions, and consent to having free of notice to the address noted on this form.

pal securities dealer, or any other financial institution, nor are you the spouse or imme-

credit balances held or invested in the Core

Position indicated above.

? Agree that the certifications, authorizations,

and appointments in this document will

diate family member residing in the same ? Consent to have only one copy of Fidelity

continue until Fidelity receives actual writ-

household of such a person.

mutual fund shareholder documents, such

ten notice of any change thereof.

? R epresent 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.

as prospectuses and shareholder reports ("Documents"), delivered to you and any other investors sharing your address. Your Documents will be householded indefinitely; however, you may revoke this consent at any time by contacting Fidelity

? Acknowledge that you will receive a monthly account statement from Fidelity, unless there are no transactions in a particular month. In any case, you will receive a statement quarterly.

at 800-343-3548 and you will begin receiv- If you are not a U.S. person:

? A cknowledge that you agree to the use of the Core Position to hold any assets of your account pending investment or other instructions and that you have received and read the prospectus or other applicable

ing multiple copies within 30 days. As Documents for other investments become available in the future, these Documents may also be householded in accordance with this authorization or any notice or

? State that you are submitting IRS Form W-8 BEN with this application to certify your foreign status and, if applicable, to claim tax treaty benefits.

documents for the Core Position.

agreement you received or entered into

? U nderstand that your Core Position is a

with Fidelity or its service providers.

money market fund, and that you could lose money by investing in a money market fund. Although the fund seeks to preserve the value of your investment at $1.00 per share, it cannot guarantee it will do so. An investment in the fund is not insured or guaranteed by the Federal Deposit Insurance Corporation

? Understand that, upon an issuer's request in accordance with applicable rules and regulations, Fidelity will supply your name to issuers of any securities held in your account so you might receive any important information regarding them, unless you notify Fidelity.

*The change in the RMD age requirement from 70? to 72 only applies to individuals who turn 70? on or after January 1, 2020. Please speak with your tax advisor regarding the impact of this change on future RMDs.

Did you sign the application and attach a check or any necessary documents (death certificate and an inheritance tax waiver if required by the deceased's state of residence)? Please return pages 1?8 and any attachments to Fidelity Investments. You will receive a "New Account Profile" confirming that your account(s) is opened.

Questions? Go to or call 1-800-544-0003.

Regular mail Fidelity Investments P.O. Box 770001 Cincinnati, OH 45277-0036

Overnight mail Fidelity Investments 100 Crosby Parkway KC1K 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.

595925.8.0 (09/20)

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