1. GENERAL INSTRUCTIONS
Opening a new account: Please complete and sign this form if you are opening a new Fidelity 403(b)(7) account and/or a 401(a) plan account
with Fidelity Investments (Fidelity accounts) and want to designate a beneficiary.
Change of Beneficiary: Please complete and sign this form if you want to change your existing beneficiary designation. In the future, you may
revoke this form and designate a different beneficiary at any time by completing and filing another Beneficiary Form with Fidelity.
No Beneficiary Designation on File: If you do not submit this completed form: (1) if you are married, your beneficiary will be your spouse;
(2) if you are not married or your spouse does not survive you, your account will be distributed according to the provisions of the plan.
Unless otherwise instructed by your employer, please return this form in the postage-paid envelope or mail it to:
Fidelity Investments, P.O. Box 770002, Cincinnati, OH 45277-0090
Questions? Please call Fidelity Investments at 1-800-343-0860, Monday through Friday, 8 a.m. to midnight Eastern time.
2. DESIGNATING YOUR BENEFICIARY(IES)
You are not limited to three primary and three contingent beneficiaries. To assign additional beneficiaries, or to designate a more
complex beneficiary designation, please attach, sign, and date a separate piece of paper.
When designating primary and contingent beneficiaries, please use whole percentages and be sure that the percentages for
each group of beneficiaries (primary and contingent) total 100%. Your primary beneficiary cannot be your contingent beneficiary. If you
designate a trust as a beneficiary, please include the trust's name and address, the name of the trustee, and the date the trust was created.