Fidelity Charitable 144/145 Contribution Form Instructions

Enter the name of the additional signatory if dual signatures are required by the firm.

Check this box if there are any agreements, contractual restrictions, lock-up agreements, or stop transfer orders relating to these securities.

Check this box if there are no agreements, contractual restrictions, lock-up agreements, or stop transfer orders relating to these securities.

Provide specific details regarding any agreements, contractual restrictions, lock-up agreements, or stop transfer orders related to these securities.

Check this box if you want to allocate your contribution to an investment pool with 20% equity exposure for instant diversification across multiple asset classes.

Enter the percentage of assets to be allocated to the 20% equity pool.

Check this box to allocate your contribution to the Asset Allocation 30% Equity investment pool for instant diversification.

Enter the percentage to be allocated to Asset Allocation 30% Equity.

Check this box if you want to allocate funds to the Asset Allocation 40% Equity pool.

Enter the percentage for the 40% Equity Asset Allocation.

Check this box to allocate your investment contribution to the Asset Allocation 50% Equity pool.

Enter the percentage of the total allocation for the Asset Allocation 50% Equity pool.

Check this box to select the Asset Allocation 60% Equity investment pool for instant diversification across multiple asset classes.

Enter the percentage of assets to be allocated to the 60% Equity investment pool.

Check this box if you want to allocate your irrevocable contribution to the 70% Equity Asset Allocation pool for instant diversification.

Enter the percentage for Asset Allocation 70% Equity.

Check this box if you want to allocate your irrevocable contribution to the Asset Allocation 85% Equity pool for instant diversification.

Enter the percentage of the total allocation for Asset Allocation 85% Equity.

Check this box if you are a donor seeking an 'all-weather' asset allocation pool with exposure to both traditional and non-traditional asset classes.

Enter the percentage of the total contribution to allocate to the Charitable Legacy Pool.

Check this box if the person's citizenship status is U.S. citizen.

Check this box if the person's citizenship status is U.S. resident alien.

Provide the full name of the company counsel contact.

Provide the professional title of the company counsel contact.

Provide the phone number for the company counsel contact.

Provide the email address for the company counsel contact.

Provide any additional comments or other pertinent information regarding the company counsel contact.

Please provide the preferred phone number for contact.

Please enter the primary street address.

Please enter the city of the contact address.

Please enter the state or province of the contact address.

Please enter the ZIP code or postal code of the contact address.

Please enter the country of the contact address.

Enter the full legal name of the financial firm delivering the securities.

Enter the account number held at the delivering firm from which the securities will be transferred.

Enter the street address of the delivering firm.

Enter the city of the delivering firm's address.

Enter the state or province of the delivering firm's address.

Enter the ZIP or postal code of the delivering firm's address.

Enter the country of the delivering firm's address.

Enter the full name of the company whose shares are being donated.

Enter the stock ticker symbol for the donated shares.

Enter the date the shares were acquired.

Enter the total number of shares acquired.

Enter the second date the shares were acquired.

Enter the total number of shares for the second acquisition.

Enter the full name of the donor or authorized party.

Check this box if the donor making the contribution is an entity (e.g., trust, partnership, or corporation).

Provide the full legal name of the entity making the donation.

Check this box if you want to allocate funds to an Environmental Impact Access investment, aligning with strategies that consider social and environmental factors while emphasizing financial returns.

Enter the percentage of assets to be allocated to Environmental Impact Access.

Enter the Fidelity account number from which the assets are being contributed.

Enter the stock certificate number(s) associated with the assets being contributed, if applicable.

Check this box if you want to include the Fixed Income Access pool as part of your custom single asset class investment strategy for your Giving Account balance.

Enter the percentage of the contribution to be allocated to the Fixed Income Access Pool.

Check this box if you want to allocate funds to a Fixed Income bond pool as part of a custom single asset class strategy.

Enter the percentage of the total allocation for Fixed Income.

Enter the giving account number.

Enter the name of the giving account.

Check this box if the donor making the contribution is the account holder.

Check this box if the donor making the contribution is a third-party donor.

Please enter the first name of the individual donor.

Please enter the middle initial of the individual donor.

Please enter the last name of the individual donor.

Check this box if you want to allocate funds to the Inflation Protected Bond Index pool within the bond asset class.

Enter the percentage of the allocation for the Inflation Protected Bond Index.

Check this box to allocate your contribution to the International Equity Access investment pool.

Enter the percentage for the International Equity Access Pool.

Check this box to allocate funds to the International Equity investment pool as part of a custom investment strategy.

Enter the percentage for the International Equity allocation.

Check this box if you want to allocate funds to the International Index pool as part of your custom investment strategy.

Enter the percentage to be allocated to the International Index pool.

Check this box if you want your irrevocable contribution to be allocated using the same percentages as your current investment pools.

Check this box if you want to specify a custom allocation method for your irrevocable contribution, as detailed below.

Enter the managed account number.

Check this box to include the Money Market pool in your custom investment strategy.

Enter the percentage allocated to the Money Market Pool.

Enter the total number of shares of the company you own.

Check this box if neither you nor any member of your household has any of the listed relationships to the company.

Check this box if you or any member of your household is an officer of the company.

Check this box if you or any member of your household is a director of the company.

Check this box if you or any member of your household is a control person, an affiliate, or holds more than 10% of the outstanding shares of the company.

Check this box if the securities were acquired through a private placement.

Check this box if the securities were acquired in exchange for payment services.

Check this box if the securities were acquired by exercising a warrant.

Check this box if the securities were acquired through a stock dividend, stock split, reverse split, or recapitalization.

Check this box if the securities were acquired as a gift, pledge, or from a trust or an estate.

Check this box if the securities were acquired as a result of a merger or company buyout.

Check this box if the securities were acquired through a partnership distribution.

Check this box if the securities were acquired by a method not listed above.

Check this box if the securities are restricted shares held in your account.

Check this box if the securities are restricted shares held in book entry form at the transfer agent.

Check this box if the securities are control shares held in your account.

Check this box if the securities are control shares held in book entry form at the transfer agent.

Check this box if the securities are both restricted and control shares held in your account.

Check this box if the securities are both restricted and control shares held in book entry form at the transfer agent.

Enter the name of the person who sold the securities, or 'N/A' if no securities were sold.

Enter the total number of shares of the company's securities that were sold.

Enter the date the securities were sold.

Enter the total number of shares being contributed.

Provide the written-out form of the number of shares being contributed.

Enter the name of the company whose shares are being contributed.

Check this box if you want to include Short-Term Fixed Income Access in your custom investment strategy for Giving Account balances.

Enter the percentage of the Short-Term Fixed Income Access pool.

Provide the Social Security Number or Tax Identification Number.

Enter the official name of the stock certificate being held in personal possession.

Enter the total number of shares associated with this stock certificate.

Provide the unique certificate number or numbers for the stock being held in personal possession.

Check this box if you want to allocate funds to the Sustainable International Index as part of your sustainable and impact investing strategy.

Enter the percentage of investment allocated to the Sustainable International Index.

Check this box if you want to allocate funds to the Sustainable U.S. Bond Index, which is part of the Sustainable and Impact Investing Pools focused on social and environmental factors.

Enter the percentage of your contribution to be allocated to the Sustainable U.S. Bond Index.

Check this box to allocate funds to the Sustainable U.S. Index as part of your sustainable and impact investing strategy for stock.

Enter the percentage to allocate to the Sustainable U.S. Index.

Check this box to allocate funds to the Sustainable U.S. Index Access investment option, a strategy considering social and environmental factors with financial returns.

Enter the percentage of the total contribution to be allocated to the Sustainable U.S. Index Access fund.

Check this box if you want to allocate funds to the Total Market Index for domestic stock within your selected investment pools.

Enter the percentage of allocation for the Total Market Index investment pool.

Check this box if you will personally initiate the transfer of assets by completing and submitting this form to Fidelity Charitable.

Check this box if you authorize Fidelity Charitable to initiate the transfer of assets on your behalf by completing and submitting this form along with your most recent account statement.

Check this box if you want to allocate funds to the U.S. Bond Index as part of your custom single asset class strategy.

Provide the percentage of funds to be allocated to the U.S. Bond Index Pool.

Check this box if you wish to allocate funds to the U.S. Equity Access investment pool within the Domestic Stock category.

Enter the percentage of the contribution to be allocated to the U.S. Equity Access Pool.

Check this box to allocate funds to the U.S. Equity domestic stock pool as part of a custom asset class strategy.

Enter the percentage of the total allocation for U.S. Equity.