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 money laundering and the funding of terrorism, federal law 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 or for beneficial own-
ers of certain accounts. Further documentation is required for certain entities, such as trusts, estates, corporations, partnerships, and other
organizations. Your account may be restricted or closed if Fidelity cannot obtain and verify this information. Fidelity will not be responsi-
ble 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, understand, 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
OWNER SIGNATURE
N
G
I X
S
TODAY’S DATE MM-DD-YYYY DL /Govt ID verified by:
E Fidelity Representative A# Initials
T
A or
D Customer not present
If applicable, introducing representative signature:
9. Terms and Conditions for This Account
By signing above, you:
• Adopt the Fidelity IRA and/or Fidelity • Acknowledge that you received the Fidelity (“Documents”), delivered to you and any
Roth IRA as indicated, appointing Fidelity Brokerage Retirement Customer Account other investors sharing your address. Your
Management Trust Company (FMTC) Agreement, the Fidelity IRA Custodial Documents, if held in eligible accounts,
(or any successor) as Custodian, and Agreement and Disclosure Statement, and will be householded indefinitely; however,
Fidelity Brokerage Services LLC (FBS) the Fidelity Roth IRA Custodial Agreement you may revoke this consent at any time
and National Financial Services LLC and Disclosure Statement; that you have by contacting Fidelity at 800-343-3548 and
(NFS) (collectively, “Fidelity”) to perform read and understand both the Customer you will begin receiving multiple copies
administrative services. Agreement and the applicable Custodial within 30 days. As Documents for other
• Acknowledge that FMTC’s acceptance of Agreement(s) that apply to the account(s) investments become available in the
its appointment as Custodian is effective you are opening with this application; and future, these Documents may also be
upon proper completion and signature that you agree to all terms and condi- householded in accordance with this autho-
of the application, and contingent upon tions on this application and in the above rization or any notice or agreement you
timely delivery of this application, as signed agreements, as these agreements may be received or entered into with Fidelity or its
and properly completed, to the Custodian, amended from time to time. service providers.
notwithstanding what is stated in Article 8, • Acknowledge that you have received the • Acknowledge that you understand prohibi-
Section 27, of the Fidelity IRA Custodial description of the Core Account in the tions on your Inherited IRA, including, but
Agreement and Article 9, Section 26, of the Customer Agreement, including Fidelity’s not limited to, the receipt of annual or roll-
Fidelity Roth IRA Custodial Agreement. right to change the options available as over contribution amounts, any attempt to
• Acknowledge that acceptance of your core positions, and consent to having free roll over the Inherited IRA to another type
application will be indicated by a Letter credit balances held or invested in the core of IRA or another Inherited IRA, and/or any
of Acceptance signed by, or on behalf position indicated above. attempt to convert the Inherited IRA to an
of, FBS, FMTC, and NFS delivered • Consent to have only one copy of Fidelity Inherited Roth IRA.
upon the Custodian’s receipt of the mutual fund shareholder documents, such
initial contribution. as prospectuses and shareholder reports
Account owner must sign and date at the end of section 8. Form continues on next page.