Fidelity Advisor Durable Power of Attorney
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Fidelity Advisor
Durable Power of Attorney
All states except New York
Use this form to establish a Durable Power of Attorney for your Fidelity Advisor account or Fidelity Advisor IRA. New York residents must
use the Fidelity Advisor NY Durable Power of Attorney form.
Type on screen or fill in using CAPITAL letters and black ink.
Helpful to Know
??A Power of Attorney (POA) is not permitted on certain
registration types, including trust accounts, business,
custodial, estate, conservator, escrow, Keogh plans,
investment-only retirement accounts, and other
fiduciary registrations. It also cannot be used for
the Fidelity Advisor 401(k) Program or other similar
employer-sponsored qualified plan programs for which
Fidelity Management Trust Company (¡°FMTC¡±) serves
as directed trustee. For retirement accounts, your
Financial Representative cannot be the Attorney-in-Fact
designated in Section 3.
??The powers you give your Attorney-in-Fact in this durable
Power of Attorney will continue to exist even if you
can no longer make your own decisions respecting the
management of your property. If you do not understand
this Power of Attorney, or any provision of it, then you
should obtain the assistance of an attorney or other
qualified person.
??Read this Durable Power of Attorney carefully. This
document gives your Attorney-in-Fact the authority
to transact on your account with the same authority
that you have as the account owner. Exception: To the
extent applicable to your account, you must specifically
designate in Section 4B that your Attorney-in-Fact has the
authority to change beneficiaries.
??Check the laws of your state for any additional
requirements. Residents of California, Maine, and
Pennsylvania: See additional notices at the end of the
document that you, and in some cases your Attorney-inFact, may be required to review and complete. Do not
use this form with a New York notary.
1. Account Owner
Check one ? ¡ö Individual??¡ö Joint??¡ö Retirement
registration type.
Registered Owner First Name
M.I.
Registered Owner Last Name
Registered Owner SSN
You must provide an
email address and mobile
phone number to be used
to verify and/or authorize
transactions.
If this is a joint account, all
account owners must sign
this Power of Attorney
in Section 6. Once it is
established, the Attorneyin-Fact can act equally for
all owners.
?
Mobile Phone Number Used as your primary phone Email Address*
Registered Joint Owner First Name (if applicable)
?
M.I.
Registered Joint Owner Last Name
Mobile Phone Number Used as your primary phone Email Address*
Fidelity Advisor Account Number
Additional Fidelity Advisor Account Number
Additional Fidelity Advisor Account Number
*See Electronic Delivery section for more details.
1.725626.121
Page 1 of 9
016330301
2. Remove Existing Power of Attorney Authorization
Complete this section ONLY if you want to remove one or more existing Attorney(s)-in-Fact from your account(s). If you
do not want to make any changes to your existing Attorneys-in-Fact, skip to Section 3. If you are not appointing a new
Attorney-in-Fact with this form, skip to Section 6. No notary or witness is required.
Check no more
than one.
¡ö
¡ö
Remove ALL existing Attorneys-in-Fact.
Remove ONLY the following Attorney(s)-in-Fact:
Attorney-in-Fact First Name
M.I.
Attorney-in-Fact Last Name
Attorney-in-Fact First Name
M.I.
Attorney-in-Fact Last Name
Attorney-in-Fact First Name
M.I.
Attorney-in-Fact Last Name
3. Add New Power of Attorney Authorization
Note: For retirement
accounts, your Financial
Representative cannot be
your Attorney-in-Fact.
All information is required.
I am the registered Account Owner of the account(s) listed in Section 1, and hereby appoint the individual named
below as my agent and Attorney-in-Fact (the ¡°Attorney-in-Fact¡±) on that account(s). The Attorney-in-Fact will have
the powers listed in Section 4A. If I so designate, the Attorney-in-Fact will also have the power listed in Section 4B.
The Attorney-in-Fact must have his or her signature notarized in Section 7.
Attorney-in-Fact First Name
M.I.
Attorney-in-Fact SSN
Attorney-in-Fact Last Name
Attorney-in-Fact Date of Birth MM DD YYYY
Attorney-in-Fact Phone Number
Mailing Address
For P.O. Box mailing
addresses, complete
U.S. Residential
Address section.
Street Address
Apartment
City
U.S. Residential Address
State
¡ö
Zip/Postal Code
Check if same as above.
Street Address
Apartment
City
State
Page 2 of 9
Zip/Postal Code
016330302
4A. Powers Granted and Terms Applicable to All Account Owners
I am the registered account owner of the account(s) referenced in Section 1 and hereby appoint the individual named in Section 3 as my
Attorney-in-Fact. The Attorney-in-Fact is hereby granted the powers listed below as well as the powers granted in any other section of this POA.
All the powers granted to the Attorney-in-Fact shall apply to the account(s) in Section 1 as well as any Fidelity Advisor Funds? account(s) or Fidelity
Advisor IRA(s)? established by the Attorney-in-Fact for the benefit of the Account Owner (the ¡°Account(s)¡±).
Powers that you, the Account Owner, grant to your Attorney-in-Fact:
??Access accounts and place trades Inquire
in, manage, dispose of, buy, sell, exchange,
and convey your personal property in the
Account(s).
??Withdraw money Request distributions
or redemptions from your Fidelity Advisor
Funds within the Account(s) regardless of
the tax consequences of such a distribution
or redemption. Such distributions or
redemptions may be requested payable
to the account owner or to the Attorneyin-Fact or to another third party.
??Take control of assets Instruct Fidelity
Investments Institutional Operations
Company LLC, (FIIOC) to distribute or
transfer to the Attorney-in-Fact any or
all cash, securities of any type, or other
property held in the Account(s) regardless
of the tax consequences of any such
distribution or transfer.
?
??Move money among accounts Initiate
rollovers, Roth IRA conversions, IRA
recharacterizations, or other transfers of
assets between and among the Account(s).
??Request statements Receive account
statements.
??Modify, close, or open accounts Establish
and/or maintain an account for the benefit
of the Account Owner in whole or in part.
Modify, amend, revoke, or terminate any of
the Accounts.
??Answer for tax matters Exercise tax
elections available to you under federal,
state, local, or foreign tax law related to your
Account(s), to the extent permitted by the
applicable taxing authority.
??Change address Change the mailing
address or address of record on the
Account(s).
??Providing or receiving information
Authorization to transmit to FIIOC in
any manner either orally, in writing,
or electronically, in accordance with
procedures established by FIIOC, from
time to time, any and all instructions
including, but not limited to, the purchase,
sale, exchange, distribution, redemption,
or transfer of shares of all funds that are
maintained by FIIOC, transfer agent, or
sub-transfer agent for the Fidelity Advisor
Funds, Destiny Funds, and certain Fidelity
Retail Funds in the Account(s).
The term ¡°Fidelity Advisor IRA¡± includes Traditional IRAs, Rollover IRAs, Roth IRAs, SIMPLE IRAs, SEP-IRAs, SARSEP-IRAs, IRA BDAs, and Roth IRA BDAs.
Terms and Conditions Applicable to All Account Owners
If I, the Account Owner, have appointed
two or more Attorneys-in-Fact on the same
account(s), I hereby authorize each of them to
act alone (severally) and without the consent
of any other Attorney-in-Fact, with respect
to each power granted above. In addition,
I acknowledge that FIIOC has the right to
restrict the Account(s) from further activity
in the event my Attorneys-in-Fact enter
conflicting or inconsistent instructions.
I understand that my Account(s) at FIIOC may
remain restricted until written instructions are
received from me, the principal, or until joint
written instructions are submitted by all of my
Attorneys-in-Fact, or until receipt of a court
order instructing FIIOC how to proceed.
FIIOC is authorized and empowered to follow
the instructions of my Attorney-in-Fact with
respect to all of the powers set forth above
and all additional optional powers initiated by
me with respect to the Account(s) with FIIOC,
provided such instructions and transactions
are permissible under the terms of my
applicable Account agreement(s) with Fidelity;
and I hereby ratify and confirm any and all
transactions, trades, or dealings effected in
and for the Account(s) by my Attorney-in-Fact,
and agree to indemnify Fidelity, its affiliates,
officers, directors, agents and employees,
successors, assigns, and control persons, and
hold them free and harmless from any loss,
liability, claim, and cost (including reasonable
attorneys¡¯ fees) or damage by reason of any
such transaction, trade, or dealing; or by
reason of any other matter or thing done by
Fidelity, its affiliates, officers, agents, and
employees, in and for the Account(s) pursuant
to instructions received from my Attorney-inFact. I understand that FIIOC has no duty to
and will not supervise or monitor any acts of
my Attorney-in-Fact on the Account(s). This
Durable Power of Attorney, authorization,
and indemnity is in addition to (and in no
way limits or restricts) any and all rights which
FIIOC may have under any other agreement
or agreements between FIIOC and me, and
shall inure and continue in favor of Fidelity,
its successors (by merger, consolidation, or
otherwise), and assigns.
This Durable Power of Attorney, authorization,
and indemnity shall not be affected by my
subsequent disability, incompetence or
incapacity, or by any lapse of time. Fidelity,
its affiliates, successors, and assigns, shall be
indemnified in relying thereon, until FIIOC shall
receive written notice of revocation, signed by
me, or written notice of termination by reason
of my death. The receipt of revocation or
termination shall in no way affect the validity
of this Durable Power of Attorney as to my
liability or my Attorney-in-Fact¡¯s liability under
the indemnity herein contained, with reference
to any transaction initiated by my Attorneyin-Fact, prior to the actual receipt by FIIOC of
notice of such revocation or termination.
To induce any transfer agent or other third
party (collectively: ¡°Third Parties¡±) to act, I
hereby agree that any Third Parties receiving a
duly executed copy or facsimile of this Durable
Power of Attorney may act upon it, and that
revocation or termination hereof shall be
ineffective as to Third Parties, unless and until
actual notice of such revocation or termination
shall have been received by such Third Parties,
and I, for myself and for my heirs, executors,
legal representatives, and assigns, hereby
agree to indemnify and hold harmless any
such Third Parties from and against any and all
claims that may arise against such Third Parties
by reason of such Third Parties having relied on
this Durable Power of Attorney.
I have read carefully the provisions of this
Durable Power of Attorney and understand
that it authorizes my Attorney-in-Fact to
exercise all rights and powers set forth and
all rights and powers indicated above with
respect to my Fidelity Advisor Funds Account(s)
or Fidelity Advisor IRA,? and I understand
that anything my Attorney-in-Fact may do
in the exercise of such rights and powers is
fully binding upon me. I understand that this
document may permit my Attorney-in-Fact to
receive compensation for services performed
and that FIIOC will not be responsible for this
compensation or for monitoring the acts of the
Attorney-in-Fact in this or any other regard.
The laws of the Commonwealth of Massachusetts shall apply to this document, except with
respect to their conflict of laws provisions.
I understand that FIIOC has not provided
any advice that this Durable Power of
Attorney satisfies the requirements under
the laws of the state in which I reside, and if
there is anything about this Durable Power
of Attorney that I do not understand, I
should consult with my own attorney for an
explanation.
continued on next page
Page 3 of 9
016330303
4A. Powers Granted and Terms Applicable to All Account Owners
continued
NOTE: If the Account Owner¡¯s state of residence changes after executing this Durable Power of Attorney, the Account Owner should
consult with his or her attorney to determine if re-execution of the form is required.
?
The term ¡°Fidelity Advisor IRA¡± includes Traditional IRAs, Rollover IRAs, Roth IRAs, SIMPLE IRAs, SEP-IRAs, SARSEP-IRAs, IRA BDAs, and Roth IRA BDAs.
This is an important legal document. Before executing this Durable Power of Attorney, note these important facts:
1. This Durable Power of Attorney is effective upon your signature on this form.
2.?Since this is a Durable Power of Attorney, your Attorney-in-Fact¡¯s authority will continue notwithstanding your subsequent mental disability
or incapacity.
3.?You have the right to revoke or terminate this Durable Power of Attorney at any time, and any such revocation or termination shall be
effective upon receipt of written notice by you to FIIOC.
4.?If there is anything about this Durable Power of Attorney you do not understand, you should consult with your own attorney. Fidelity does
not provide legal advice.
4B. Authorization to Designate Beneficiaries
Note: Some states do not
allow Attorneys-in-Fact
to appoint themselves
as beneficiaries. Consult
with an attorney or other
qualified person before
completing this section.
Account Owner Initials
By initialing this box I understand that I am granting the Attorney-in-Fact listed in Section 3
the power to designate beneficiaries or change existing beneficiary designations, including
the power to designate him/herself as the beneficiary on Account(s) as defined in Section 4A,
provided, however, that such account(s) is either a Fidelity Advisor IRA? or a Transfer on Death
account. Notwithstanding the foregoing, I also understand that I am granting the Attorney-inFact the power to establish a Transfer on Death registration on a nonretirement account.
?
The term ¡°Fidelity Advisor IRA¡± includes Traditional IRAs, Rollover IRAs, Roth IRAs, SIMPLE IRAs,
SEP-IRAs, SARSEP-IRAs, IRA BDAs, and Roth IRA BDAs.
5. 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.
Page 4 of 9
016330304
6. Account Owner(s) Signatures and Dates
presence of a notary public and two witnesses.
Account owner must sign and date this form in the
The undersigned has read the foregoing (Sections 1¨C4B) in its entirety, and by signing below, I agree to the terms within.
Print Registered Owner Name First, M.I., Last
MM - DD - YYYY
Registered Joint Owner Signature if applicable*
Date
MM - DD - YYYY
SIGN
Date
SIGN
Registered Owner Signature
Print Registered Joint Owner Name First, M.I., Last
* This signature also designates the person in Section 3 as Agent under this Durable Power of Attorney for the Registered Joint Owner. Check your state¡¯s
requirements to determine what the signature requirements are for a Durable Power of Attorney.
Statement of Notary Public In this section, ¡°You¡± and ¡°you¡± refer to the Notary Public.
You certify that the individual signing above appeared before you on the date indicated below, that they are known to you to be the individuals
they claim to be, and that they represented to you that they made the certifications above their signature of their own free will.
Important 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
NOTARIZATION 1
State
County
Print Notary Name
Commission Expires MM - DD - YYYY
Date
MM - DD - YYYY
SIGN
Notary Signature
Identification
¨‹ NOTARY STAMP OR SEAL ¨‹
Print Witness 1 Name First, M.I., Last
Date
MM - DD - YYYY
Witness 2 Signature
Date
SIGN
SIGN
Witness 1 Signature
Print Witness 2 Name First, M.I., Last
Page 5 of 9
016330305
MM - DD - YYYY
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