Fidelity Advisor Trading Authorization and Indemnification Instructions
This form contains 87 fields organized into 20 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Account Number | ||
| Account Number | Text |
Enter the account number for this account.
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| Account Registration Type | ||
| Individual/Joint | Checkbox |
Check this box if the account is registered as an individual or joint account.
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| Corporate | Checkbox |
Check this box if the account is registered as a corporate entity.
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| Investment Only Retirement | Checkbox |
Check this box if the account is an Investment Only, Non-prototype Retirement account where Fidelity Management Trust Company is not the trustee or custodian.
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| Fidelity Advisor IRAs | Checkbox |
Check this box if the account is a Fidelity Advisor IRA, including Traditional, Roth, Rollover, SIMPLE, SEP, or SARSEP/BDA types.
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| Fiduciary | Checkbox |
Check this box if the account is a Fiduciary account, such as a Trust, UGMA/UTMA, Estate, Conservatorship, or Guardianship.
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| Agent Authorization Action | ||
| Replacing All Agents | Checkbox |
Check this box if you are changing all previously authorized agents and replacing them with the agent(s) listed below.
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| Adding Agent | Checkbox |
Check this box if you are adding the person listed below as an Authorized Agent in addition to any agents previously authorized.
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| Authorized Agent 1 Signature Date | ||
| Authorized Agent 1 Signature Date | Date |
Enter the date when Authorized Agent 1 provided their signature.
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| Authorized Agent 2 Signature Date | ||
| Authorized Agent 2 Signature Date | Date |
Enter the date the Authorized Agent 2 signed the document.
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| Authorized Agent 3 Signature Date | ||
| Authorized Agent 3 Signature Date | Date |
Enter the date of the third authorized agent's signature.
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| Authorized Agent 4 Signature Date | ||
| Agent 4 Signature Date | Date |
Enter the date the Authorized Agent 4 signed this form.
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| Authorized Agent 5 Signature Date | ||
| Authorized Agent 5 Signature Date | Date |
Please enter the date the fifth authorized agent signed.
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| Fifth Authorized Individual | ||
| Fifth Authorized Individual First Name | Text |
Enter the first name of the fifth authorized individual.
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| Fifth Authorized Individual Middle Initial | Text |
Enter the middle initial of the fifth authorized individual.
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| Fifth Authorized Individual Last Name | Text |
Enter the last name of the fifth authorized individual.
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| Fifth Authorized Individual - Inquiry Only | Checkbox |
Check this box if the Fifth Authorized Individual is authorized for inquiry only (viewing balances, account history, and clerical information) and no financial transactions are permitted.
|
| Fifth Authorized Individual - Limited Trading Authorization | Checkbox |
Check this box if the Fifth Authorized Individual is authorized for inquiry, trading (including exchanges and redemptions to registered account holder or pre-established bank), or for payment of advisory fees.
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| Fifth Authorized Individual - All Authorization | Checkbox |
Check this box if the Fifth Authorized Individual is authorized for all transactions, including purchases, redemptions, exchanges, transfers, and distributions to any party.
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| Fifth Authorized Individual SSN | Text |
Enter the Social Security Number of the fifth authorized individual.
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| Fifth Authorized Individual Date of Birth | Date |
Enter the date of birth for the fifth authorized individual.
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| Financial Advisor Information | ||
| Financial Advisor First Name | Text |
Enter the first name of the financial advisor.
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| Financial Advisor M.I. | Text |
Enter the middle initial of the financial advisor, if applicable.
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| Financial Advisor Last Name | Text |
Enter the last name of the financial advisor.
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| Financial Advisor Phone | Text |
Enter the phone number of the financial advisor.
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| Financial Advisor Fax | Text |
Enter the fax number of the financial advisor.
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| First Authorized Individual | ||
| First Authorized Individual First Name | Text |
Please enter the first name of the first authorized individual.
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| First Authorized Individual Middle Initial | Text |
Please enter the middle initial of the first authorized individual.
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| First Authorized Individual Last Name | Text |
Please enter the last name of the first authorized individual.
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| First Authorized Individual - Inquiry Only | Checkbox |
Check this box if the First Authorized Individual is authorized to only inquire about account information, such as viewing share balances and account history, with no financial transactions permitted.
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| First Authorized Individual - Limited Trading Authorization | Checkbox |
Check this box if the First Authorized Individual is authorized to inquire, trade within the account, and redeem mutual fund shares to the registered account holder or for payment of financial advisory fees.
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| First Authorized Individual - All Trading Authorization | Checkbox |
Check this box if the First Authorized Individual is authorized to inquire and request all types of transactions, including purchases, redemptions, exchanges, or transfers of shares.
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| First Authorized Individual SSN | Text |
Please enter the Social Security Number of the first authorized individual.
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| First Authorized Individual Date of Birth | Date |
Please enter the date of birth for the first authorized individual.
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| Fourth Authorized Individual | ||
| AP/AGT_AuthIndivFirstName04 | Text | |
| AP/AGT_AuthIndivMI04 | Text | |
| AP/AGT_AuthIndivLastName04 | Text | |
| Fourth Authorized Individual - Inquiry Only (I) | Checkbox |
Check this box if the fourth authorized individual should have Inquiry Only (I) authority.
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| Fourth Authorized Individual - Limited Trading (L) | Checkbox |
Check this box if the fourth authorized individual should have Limited Trading (L) authority.
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| Fourth Authorized Individual - All (A) | Checkbox |
Check this box if the fourth authorized individual should have All (A) trading authority.
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| AP/AGT_SSN_TIN04 | Text | |
| API/AGT_DOB04 | Text | |
| General | ||
| Button | ||
| Reset | Button | |
| Joint Owner Information | ||
| Joint Owner First Name | Text |
Enter the first name of the joint owner.
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| Joint Owner Middle Initial | Text |
Enter the middle initial of the joint owner.
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| Joint Owner Last Name | Text |
Enter the last name of the joint owner.
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| Joint Owner Mobile Phone Number | Text |
Enter the mobile phone number for the joint owner, which will be used as their primary phone number.
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| Joint Owner Email Address | Text |
Enter the email address for the joint owner.
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| Notarization 1 | ||
| Notarization 1 State | Text |
Enter the state where the notarization is taking place for Notarization 1.
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| Notarization 1 County | Text |
Enter the county where the notarization is taking place for Notarization 1.
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| Notarization 1 Identification | Text |
Enter the identification details of the individual being notarized for Notarization 1.
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| Notarization 1 Printed Notary Name | Text |
Enter the printed name of the Notary Public for Notarization 1.
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| Notarization 1 Commission Expiration Date | Date |
Enter the date when the notary's commission expires for Notarization 1.
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| Notarization 1 Notary Signature Date | Date |
Enter the date the Notary Public signed the document for Notarization 1.
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| Notarization 2 | ||
| Notarization 2 State | Text |
Enter the state where the notarization is taking place.
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| Notarization 2 County | Text |
Enter the county where the notarization is taking place.
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| Notarization 2 Identification | Text |
Provide details regarding the identification of the individual being notarized.
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| Notarization 2 Printed Notary Name | Text |
Enter the full printed name of the notary public.
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| Notarization 2 Commission Expiration Date | Date |
Provide the date when the notary public's commission expires.
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| Notarization 2 Notary Signature Date | Date |
Provide the date the notary public signed the document.
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| Page 4 | ||
| SaD_PrintParticipantName | Text | |
| RO_Date | Text | |
| SaD_PrintParticipantName02 | Text | |
| RO_Date02 | Text | |
| Registered Owner Information | ||
| Registered Owner First Name | Text |
Enter the first name of the registered owner.
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| Registered Owner M.I. | Text |
Enter the middle initial of the registered owner.
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| Registered Owner Last Name or Organization Name | Text |
Enter the last name of the registered owner, or the name of the organization or trust if applicable.
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| Registered Owner SSN or TIN | Text |
Enter the Social Security Number (SSN) or Taxpayer Identification Number (TIN) of the registered owner.
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| Registered Owner Mobile Phone Number | Text |
Enter the primary mobile phone number for the registered owner.
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| Registered Owner Email Address | Text |
Enter the email address for the registered owner.
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| Second Authorized Individual | ||
| Second Authorized Individual First Name | Text |
Enter the first name of the second authorized individual.
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| Second Authorized Individual Middle Initial | Text |
Enter the middle initial of the second authorized individual.
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| Second Authorized Individual Last Name | Text |
Enter the last name of the second authorized individual.
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| Second Authorized Individual - Inquiry Only | Checkbox |
Check this box if the Second Authorized Individual is only permitted to inquire about the account (view balances, history, etc.) but cannot perform financial transactions.
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| Second Authorized Individual - Limited Trading Authorization | Checkbox |
Check this box if the Second Authorized Individual is permitted to inquire, trade in the account, including exchanges and redemption of mutual funds, or for payment of financial advisory service fees.
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| Second Authorized Individual - All Trading Authorization | Checkbox |
Check this box if the Second Authorized Individual is authorized to request all transactions, including purchases, redemptions, exchanges, or transfers of shares.
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| Second Authorized Individual SSN | Text |
Enter the Social Security Number of the second authorized individual.
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| Second Authorized Individual Date of Birth | Date |
Enter the date of birth for the second authorized individual.
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| Third Authorized Individual | ||
| Third Authorized Individual First Name | Text |
Enter the first name of the third authorized individual.
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| Third Authorized Individual Middle Initial | Text |
Enter the middle initial of the third authorized individual.
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| Third Authorized Individual Last Name | Text |
Enter the last name of the third authorized individual.
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| Third Individual - Inquiry Only | Checkbox |
Check this box if the third authorized individual should only be able to inquire about the account, such as viewing balances and account history, with no financial transactions permitted.
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| Third Individual - Limited Trading Authorization | Checkbox |
Check this box if the third authorized individual should be able to inquire and trade in the account, including exchanges, redemptions of mutual fund shares, or for the payment of financial advisory service fees.
|
| Third Individual - All Trading Authorization | Checkbox |
Check this box if the third authorized individual should be able to request all transactions on the account, including purchases, redemptions, exchanges, or transfers of shares, with distributions payable to the registered account owner, the Authorized Agent, or any other third party.
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| Third Authorized Individual SSN | Text |
Enter the Social Security Number of the third authorized individual.
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| Third Authorized Individual Date of Birth | Date |
Enter the date of birth of the third authorized individual.
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