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 Fidelity.com/beneficiary.
Primary Beneficiaries
For each beneficiary Spouse Name If naming spouse as a beneficiary, do so here.
you list by name,
check a beneficiary Non-Spouse
type and provide Trust Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
all information. Per stirpes
Other Entity %
If you outlive the
beneficiary and you
want that beneficiary’s Name
share to go to each of Non-Spouse
his or her descendants,
check “per stirpes.” Trust Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
As an alternative Other Entity % Per stirpes
to listing each of your
children by name,
you can check “Non- Name
spouse” and insert Non-Spouse
“All my children” in
the “Name” box. Trust
Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
Other Entity % Per stirpes
%
Total must add up to 100%.
Contingent Beneficiaries
Contingent beneficia- Spouse Name If naming spouse as a beneficiary, do so here.
ries receive assets only
if no primary beneficiary Non-Spouse
survives you. Trust Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
Per stirpes
Do NOT list any primary Other Entity %
beneficiaries here.
As an alternative
to listing each of your Name
children by name, Non-Spouse
you can check “Non- Trust
spouse” and insert Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
“All my children” in the Other Entity % Per stirpes
“Name” box.
Name
Non-Spouse
Trust
Social Security or Taxpayer ID Number Date of Birth M M DD YYYY Share Percentage
Other Entity % Per stirpes
%
Total must add up to 100%.
Account owner must sign and date at the end of section 8. Form continues on next page.