Fidelity Trusted Contact Authorization Form Completed Form Examples and Samples

View a real-world example of a completed Fidelity Trusted Contact Authorization Form. Our sample shows exactly how to fill out account owner information, trusted contact details, relationship, and signature fields — helping you complete your own form quickly and correctly.
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Completed Fidelity Trusted Contact Authorization Form designating an adult child as trusted contact for a retired account holder

Fidelity Trusted Contact Authorization Form Example – Adult Child as Trusted Contact

How this form was filled:

A retired account holder designates their adult daughter as a trusted contact on their Fidelity brokerage account. The form includes the account owner's full name and account number, the trusted contact's full name, relationship, phone number, email address, and mailing address. The form is signed and dated by the account owner in January 2026.

Information used to fill out the document:

  • Account Owner Full Name: Margaret L. Thornton
  • Account Owner Address: 47 Birchwood Lane, Austin, TX 78701
  • Account Owner Phone Number: 512-555-0184
  • Fidelity Account Number: Z48-293751
  • Trusted Contact Full Name: Claire E. Thornton
  • Relationship to Account Owner: Adult Child (Daughter)
  • Trusted Contact Phone Number: 512-555-0237
  • Trusted Contact Email Address: [email protected]
  • Trusted Contact Mailing Address: 210 Oakdale Drive, Austin, TX 78745
  • Account Owner Signature: Margaret L. Thornton
  • Date Signed: 01/14/2026

What this filled form sample shows:

  • Correctly completed account owner information including full legal name and account number
  • Properly designated trusted contact with full name and clearly stated relationship to the account owner
  • Complete trusted contact details including phone number, email address, and mailing address
  • Clear use case scenario reflecting a retired individual protecting against financial exploitation or health-related incapacity
  • Properly formatted signature and date in January 2026
  • Demonstrates how Fidelity can contact a trusted person without granting them trading or account access authority

Form specifications and details:

Use Case: Retired account holder designating an adult child as trusted contact
Account Type: Individual Fidelity Brokerage Account
Trusted Contact Relationship: Adult Child (Daughter)
Purpose of Trusted Contact: To be contacted by Fidelity regarding account owner's health, safety, or potential financial exploitation
Trusted Contact Authority: Contact only – no trading or account access granted
Form Submission Method: Mail or in-person delivery to Fidelity branch
Applicable Regulation: FINRA Rule 4512 – Customer Account Information
Date Completed: January 14, 2026
Categories: authorization forms, Fidelity forms, trust forms
Created: February 25, 2026 06:09 AM
Completed Fidelity Trusted Contact Authorization Form designating an adult child as trusted contact for a retired account holder