Power of Attorney Form for Fidelity

INSTITUTIONAL DURABLE POWER OF ATTORNEY AND ACCOUNT AUTHORIZATION

DESIGNATED BROKERAGE CUSTODIAN: FIDELITY BROKERAGE SERVICES LLC / NATIONAL FINANCIAL SERVICES LLC

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DOCUMENT CONTROL INFORMATION

• Document Identification: POA-FID-INST-2024-V4.2
• Effective Date: [Effective Date]
• Document Version: Version 4.2 (Institutional / Durable Financial & Brokerage Authorization)
• Governing Jurisdiction: State of [Governing State / Jurisdiction]
• Broker-Dealer / Custodian Reference: Fidelity Brokerage Services LLC ("FBS") and its clearing affiliate, National Financial Services LLC ("NFS") (collectively, "Fidelity")

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STATUTORY AND LEGAL COMPLIANCE NOTICE

NOTICE TO PRINCIPAL: THIS IS A DURABLE, INSTITUTIONAL-GRADE LEGAL INSTRUMENT. THE POWERS GRANTED UNDER THIS POWER OF ATTORNEY ARE BROAD, SWEEPING, AND SWIFTLY ACTIONABLE UPON PRESENTMENT TO FIDELITY BROKERAGE SERVICES LLC AND NATIONAL FINANCIAL SERVICES LLC. BY EXECUTING THIS DOCUMENT, YOU ARE GRANTING YOUR DESIGNATED ATTORNEY-IN-FACT (HEREINAFTER, "AGENT") UNRESTRICTED ACCESS AND DISCRETIONARY AUTHORITY OVER YOUR FIDELITY BROKERAGE, CASH MANAGEMENT, RETIREMENT, AND/OR MARGIN ACCOUNTS, WHICH MAY INCLUDE THE POWER TO TRADE SECURITIES, ENTER INTO DEBT OBLIGATIONS ON MARGIN, DRAW CHECKS, DIRECT WIRE TRANSFERS, AND EXPEND ASSETS. THIS POWER OF ATTORNEY WILL REMAIN IN FULL FORCE AND EFFECT NOTWITHSTANDING YOUR SUBSEQUENT DISABILITY, INCAPACITY, OR INCOMPETENCY, UNLESS EXPLICITLY REVOKED IN WRITING BY YOU ACCORDING TO THE PROCEDURES PRESCRIBED HEREIN. YOU RETAIN THE RIGHT TO REVOKE OR AMEND THIS INSTRUMENT AT ANY TIME SUBJECT TO COMPLETED WRITTEN NOTICE TO FIDELITY. IF THERE ARE QUESTIONS REGARDING THE LEGAL IMPLICATIONS OF THIS DOCUMENT, CONSULT INDEPENDENT LEGAL COUNSEL LICENSED IN THE GOVERNING JURISDICTION PRIOR TO EXECUTION.

NOTICE TO AGENT: BY ACCEPTING THIS APPOINTMENT, YOU ENTER INTO A FIDUCIARY RELATIONSHIP WITH THE PRINCIPAL. YOU ASSUME THE SERIOUS LEGAL, EQUITABLE, AND STATUTORY RESPONSIBILITIES OF A FIDUCIARY UNDER APPLICABLE STATE LAW. YOU MUST ACT HONESTLY, LOYALLY, AND IN UTMOST GOOD FAITH IN THE EXCLUSIVE INTEREST OF THE PRINCIPAL. YOU MUST PREVENT CONFLICTS OF INTEREST, SEGREGATE ASSETS, MAINTAIN ACCURATE ACCOUNTINGS, AND EXERCISE PRUDENT FINANCIAL JUDGMENT. YOU ARE EXPRESSLY PROHIBITED FROM ENGAGING IN UNAUTHORIZED SELF-DEALING OR COMINGLING FUNDS, UNDER PENALTY OF CIVIL AND CRIMINAL LAW.

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1. PARTIES AND ACCOUNT RECITALS

1.1. Principal

This Durable Power of Attorney is made, executed, and delivered by:

• Principal Legal Name: [Principal Full Legal Name]
• Residential Street Address: [Principal Street Address, Suite/Apt]
• City, State, Zip Code: [City, State, Zip Code]
• Social Security Number / TIN (Last 4 Digits): [XXX-XX-____]
• Primary Telephone Number: [Principal Phone Number]

1.2. Designated Attorney-in-Fact (Agent)

The Principal hereby irrevocably designates and appoints the following individual as the true and lawful Attorney-in-Fact (hereinafter referred to as the "Agent"):

• Agent Legal Name: [Agent Full Legal Name]
• Residential Street Address: [Agent Street Address, Suite/Apt]
• City, State, Zip Code: [City, State, Zip Code]
• Social Security Number / TIN (Last 4 Digits): [XXX-XX-____]
• Primary Telephone Number: [Agent Phone Number]
• Relationship to Principal: [Relationship to Principal, e.g., Spouse, Child, Corporate Trustee, Independent Professional Fiduciary]

1.3. Successor Attorney-in-Fact (Alternate Agent)

In the event that the primary Agent designated above dies, resigns, becomes mentally or physically incapacitated, refuses to act, is judicially removed, or is otherwise disqualified by operation of law, the Principal hereby designates and appoints the following individual as Successor Attorney-in-Fact:

• Successor Agent Legal Name: [Successor Agent Full Legal Name]
• Residential Street Address: [Successor Agent Street Address, Suite/Apt]
• City, State, Zip Code: [City, State, Zip Code]
• Social Security Number / TIN (Last 4 Digits): [XXX-XX-____]
• Primary Telephone Number: [Successor Agent Phone Number]
• Relationship to Principal: [Relationship to Principal]

1.4. Designated Fidelity Accounts

This instrument applies directly, comprehensively, and specifically to all securities, commodities, margin, cash management, mutual fund, custodial, individual retirement, and other accounts maintained by or on behalf of the Principal with Fidelity Brokerage Services LLC, National Financial Services LLC, Fidelity Investments, or their affiliates, whether currently existing or opened hereafter (collectively, the "Subject Accounts"). Specific existing designated accounts include, without limitation:

• Account 1 Number: [Fidelity Account Number 1] — Account Title: [Exact Title on Fidelity Account 1]
• Account 2 Number: [Fidelity Account Number 2] — Account Title: [Exact Title on Fidelity Account 2]
• Account 3 Number: [Fidelity Account Number 3] — Account Title: [Exact Title on Fidelity Account 3]
• Catch-All Brokerage Election: [MARK 'X' IF APPLICABLE: [ ] ] ALL accounts of any kind or nature registered under the Principal's name or Social Security Number / Taxpayer Identification Number with Fidelity Brokerage Services LLC, National Financial Services LLC, and any affiliated entity.

1.5. Recitals of Authority

WHEREAS, the Principal maintains investment, brokerage, custodial, and cash balance assets managed through Fidelity; and
WHEREAS, the Principal desires to grant full, plenary, durable financial and operational management authority over the Subject Accounts to the designated Agent, empowering said Agent to manage, trade, withdraw, pledge, liquidate, borrow against, and execute any transactions upon the Subject Accounts as fully and completely as the Principal could do if personally present and acting; and
WHEREAS, the Principal intends that Fidelity Brokerage Services LLC, National Financial Services LLC, and all clearing or transfer agents rely unconditionally upon the valid exercise of powers granted under this instrument;

NOW, THEREFORE, the Principal hereby incorporates the foregoing recitals and enacts the following operative legal covenants, mandates, and authorities.

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2. OPERATIVE CLAUSES & APPOINTMENT OF POWERS

SECTION 2.01: SCOPE OF ENGAGEMENT AND BROAD DISCRETIONARY TRADING POWERS

The Principal hereby confers upon the Agent complete, non-restricted, discretionary trading authorization over the Subject Accounts. The Agent is authorized, empowered, and instructed to:

1. Securities Transactions: Buy, sell (long and short), exchange, convert, tender, hold, assign, or otherwise liquidate and trade all forms of securities, whether traded on public exchanges, over-the-counter, foreign markets, or privately placed. This includes, without limitation, common and preferred corporate stock, American Depositary Receipts (ADRs), municipal and corporate bonds, convertible debt instruments, United States Treasury and federal agency securities, exchange-traded funds (ETFs), open-end and closed-end mutual funds, real estate investment trusts (REITs), certificates of deposit, money market instruments, commercial paper, master limited partnerships (MLPs), and structured products.
2. Derivatives and Option Contracts: Write, buy, sell, exercise, spread, straddle, assign, or close out options contracts, equity options, index options, interest rate options, and futures instruments, subject only to the standard option authorization tiers approved for the Subject Accounts by Fidelity.
3. Order Types and Instructions: Enter, execute, modify, substitute, or cancel orders of every kind, including, without limitation, market orders, limit orders, stop-loss orders, trailing stops, good-'til-canceled (GTC) orders, all-or-none, immediate-or-cancel, fill-or-kill, and after-hours execution mandates.

SECTION 2.02: CASH DISBURSEMENTS, TRANSFERS, AND THIRD-PARTY DISTRIBUTIONS

The Principal confers upon the Agent the direct, unrestrained power to execute monetary transactions out of the Subject Accounts:

1. Wire and Automated Clearing House (ACH) Transfers: Initiate, authorize, and verify outbound federal wire transfers, ACH standing orders, Electronic Funds Transfers (EFT), Real-Time Payments (RTP), and internal account-to-account journals. The Agent is authorized to deliver funds to accounts registered in the Principal’s name, accounts held jointly, or, if explicitly permitted under Section 2.05 herein, accounts registered to third parties.
2. Check Writing and Debit Management: Draw, issue, endorse, and deliver checks against the Subject Accounts utilizing the Fidelity cash management checkwriting features; issue stop-payment orders; and control, activate, or replace debit card services associated with the Subject Accounts.
3. Retirement Account Distributions: With respect to any Individual Retirement Account (Traditional, Roth, SEP, SIMPLE) or qualified plan account held at Fidelity in the Principal's name: calculate, elect, modify, or direct distributions, including Minimum Required Distributions (MRDs/RMDs) under Internal Revenue Code Section 401(a)(9); elect state and federal income tax withholding rates; and direct standard, premature, or corrective return-of-excess contribution distributions.

SECTION 2.03: CREDIT, MARGIN, AND COLLATERALIZATION POWERS

The Principal hereby grants the Agent plenary authority to utilize and extend credit facilities via Fidelity:

1. Margin Utilization: Maintain existing margin agreements or execute new margin loan documents; borrow funds from National Financial Services LLC or Fidelity Brokerage Services LLC against the assets held within the Subject Accounts; purchase securities on margin; and pledge, hypothecate, or rehypothecate securities held in the Subject Accounts as security for any such margin credit or indebtedness.
2. Collateral and Guarantees: Pledge, encumber, assign, or hypothecate assets in the Subject Accounts as collateral security for loans, guarantees, or credit facilities extended to the Principal or on behalf of the Principal’s legal, corporate, or financial affairs.
3. Maintenance and Margin Calls: Respond to, satisfy, liquidate assets against, or negotiate terms regarding margin maintenance calls, house calls, or regulatory deficit demands issued by Fidelity.

SECTION 2.04: ADMINISTRATIVE, TAX, AND CORPORATE ACTIONS

The Principal grants the Agent full administrative and corporate proxy power over the Subject Accounts:

1. Corporate Actions: Direct, execute, or decline rights offerings, tender offers, stock splits, exchange privileges, warrant exercises, corporate recapitalizations, debt restructurings, and bankruptcy creditor proofs of claim.
2. Proxy Voting and Shareholder Governance: Exercise all voting, proxy, and consent rights appurtenant to securities held in the Subject Accounts, or expressly delegate proxy voting authority to investment managers, custodians, or advisory firms.
3. Tax Documentation and Access: Access, view, download, receive, and inspect all Form 1099s, Form 5498s, schedule reports, transaction confirmations, year-end account summaries, and related tax disclosures. The Agent is authorized to verify or furnish replacement Forms W-9 or W-8BEN, as appropriate, certifying the Principal's tax identification status under penalties of perjury.
4. Digital and Online Access: Create, manage, administer, and maintain institutional or retail electronic log-in credentials, two-factor authentication modalities, electronic delivery consents, and online communications with Fidelity on behalf of the Principal.

SECTION 2.05: GIFTING, TRANSFERS, AND SELF-DEALING LIMITATIONS

(Select and enforce explicit operational governance regarding self-benefiting and gratuitous transactions):

1. General Prohibition on Self-Dealing: Except as expressly authorized in Subsection (2) below, the Agent is strictly prohibited from directing disbursements, transferring assets, or conveying equity from the Subject Accounts to the Agent, the Agent's estate, the Agent's creditors, or the creditors of the Agent's estate, unless such transfer is directly supported by fair and full market consideration or legal obligation owed by the Principal.
2. Limited Gifting Authority / Permissible Self-Distributions:
   • Gifting Power Granted: [MARK 'X' IF APPLICABLE: [ ] ]
   • If marked, the Agent may make gifts from the Subject Accounts to the Principal's descendants, spouse, or recognized 501(c)(3) charitable institutions in amounts not exceeding the federal annual gift tax exclusion under Internal Revenue Code Section 2503(b) (including split gifts under IRC Section 2513) per donee per calendar year.
   • If the designated Agent is a child or spouse of the Principal, the Agent [IS / IS NOT] authorized to receive an annual gift within the parameters of said statutory exclusion limit.

SECTION 2.06: AGENT COMPENSATION AND EXPENSE REIMBURSEMENT

1. Reimbursement of Expenses: The Agent is entitled to direct reimbursement out of the cash reserves of the Subject Accounts for all actual, documented, reasonable, and necessary out-of-pocket expenses incurred in the performance of their fiduciary duties hereunder, including reasonable professional fees (legal, accounting, and advisory).
2. Compensation Rate: The Agent shall:
   • [MARK 'X' FOR OPTION A: [ ] ] Serve without compensation, solely entitled to direct reimbursement for out-of-pocket expenses.
   • [MARK 'X' FOR OPTION B: [ ] ] Receive reasonable compensation for services rendered, defined as a fee equal to [Hourly Rate in USD, e.g., $150.00] per hour, or an annual administrative retainer of [Annual Retainer in USD, e.g., $5,000.00], payable quarterly in arrears directly from the Subject Accounts, subject to the review and prior written authorization of the independent legal/tax advisor designated by the Principal.

SECTION 2.07: DURATION, INCAPACITY, AND LEGAL EFFECT (DURABILITY CLAUSE)

1. Durability Clause: This Power of Attorney is DURABLE. It shall not be affected, diminished, terminated, or impaired by the subsequent mental, physical, cognitive, or legal disability, incapacity, incompetence, or illness of the Principal. All acts done by the Agent pursuant to this instrument during any period of the Principal’s disability or incapacity shall have the same effect and inure to the benefit of and bind the Principal and the Principal’s heirs, devisees, legatees, personal representatives, and successors in interest.
2. Springing vs. Immediate Operation:
   • This instrument shall take effect:
     • [MARK 'X' FOR IMMEDIATE: [ ] ] Immediately upon valid notarized execution and delivery to Fidelity Brokerage Services LLC / NFS.
     • [MARK 'X' FOR SPRINGING: [ ] ] Only upon the certified incapacity of the Principal, attested to in writing by two (2) independent medical doctors licensed to practice medicine in the jurisdiction of the Principal's residence, certifying that the Principal lacks executive cognitive capacity to manage their personal financial affairs.

SECTION 2.08: RELIANCE, EXONERATION, AND INDEMNIFICATION OF FIDELITY

1. Third-Party Absolute Reliance: The Principal expressly authorizes and directs Fidelity Brokerage Services LLC, National Financial Services LLC, and their ultimate corporate parent (FMR LLC), affiliates, officers, directors, employees, and agents, to honor, process, and fully comply with every order, notice, instruction, liquidation, transfer, or direction given by the Agent named herein without inquiring into the circumstances of its issuance, the validity of its intent, the application of proceeds, or the bona fides of the Agent.
2. Exoneration of Custodian: Fidelity shall incur no liability to the Principal, the Principal’s estate, heirs, personal representatives, creditors, or assignees, for executing any instructions or orders delivered by the Agent prior to the actual receipt by an authorized legal officer of Fidelity of written, formal, signed notice of the Principal's revocation, judicial declaration of invalidity, or death.
3. Indemnification Agreement: The Principal, for themselves, their estate, beneficiaries, executors, administrators, and assigns, hereby covenants and agrees to indemnify, hold harmless, and defend Fidelity, its affiliates, agents, directors, and employees, from and against any and all claims, demands, liabilities, damages, losses, expenses, costs, judgments, and legal fees (including in-house and outside attorneys’ fees and costs) arising out of, relating to, or resulting from Fidelity's good faith reliance on this Power of Attorney or execution of any instructions submitted by the Agent under this instrument.
4. Presumption of Continuance: In the absence of written notification to the contrary received by Fidelity, Fidelity may conclusively presume that this Power of Attorney has not been amended, revoked, suspended, or superseded, and that the Agent continues to possess full legal capacity and statutory authority to bind the Principal. Any copy or facsimile of this executed Power of Attorney, certified as true and correct by the Agent, Notary, or an attorney-at-law, may be accepted and treated by Fidelity with the same binding force, validity, and evidentiary effect as the original executed document.

SECTION 2.09: REVOCATION, TERM, AND TERMINATION

1. Methods of Revocation: The Principal may revoke this Power of Attorney at any time while possessing full legal competence. Revocation must be in writing, signed by the Principal, acknowledged before a Notary Public, and delivered via certified mail or secure institutional electronic transmission directly to the legal / compliance operations department of Fidelity Brokerage Services LLC.
2. Effective Time of Revocation: No revocation shall be effective against Fidelity until it has actually been received, processed, and acknowledged by Fidelity’s central brokerage operations or legal department, allowing for an operationally reasonable administrative review period (not to exceed two (2) business days from confirmed delivery). Any transaction executed, entered, cleared, or committed to prior to the completion of such processing shall remain fully valid, binding, and indemnified.
3. Automatic Termination Events: This Power of Attorney shall terminate automatically upon:
   • The death of the Principal (subject to the condition that transactions initiated by the Agent prior to Fidelity’s actual receipt of a certified death certificate remain governed by Section 2.08);
   • The formal written resignation, death, or adjudicated incapacity of the Agent, provided no designated Successor Agent is ready, willing, and able to assume responsibilities;
   • The issuance of a final, unappealable judicial decree of a court of competent jurisdiction terminating this power or appointing a plenary conservator/guardian over the estate of the Principal.

SECTION 2.10: FIDUCIARY DUTIES, STANDARDS OF CARE, AND ACCOUNTINGS

1. Fiduciary Standard: The Agent shall act in accordance with the highest fiduciary standards of integrity, loyalty, prudence, and duty of care under the Uniform Power of Attorney Act (or the corresponding statutory framework of the governing jurisdiction). The Agent must make investment and transactional decisions designed strictly to advance the health, support, preservation, maintenance, and best financial interests of the Principal.
2. Duty of Prudence: The Agent shall invest and manage the Subject Accounts as a prudent investor would, taking into consideration the purposes, terms, distribution requirements, risk tolerances, and other circumstances of the Principal.
3. Duty to Account: The Agent shall maintain a detailed, contemporaneous ledger of all trades, transfers, receipts, withdrawals, and disbursements processed through the Subject Accounts. Upon written demand from the Principal, the Principal's legal guardian, or any court of competent jurisdiction, the Agent shall render a full, complete, and sworn formal accounting of all transactions within thirty (30) days of receipt of such demand.

SECTION 2.11: REPRESENTATIONS AND WARRANTIES

1. Principal Representations: The Principal warrants and covenants that:
   • The Principal is of sound mind, legal majority, and full legal capacity to execute this instrument;
   • The Principal has unencumbered ownership and legal right of disposition regarding all assets located in the Subject Accounts;
   • The execution of this instrument is the voluntary act and deed of the Principal, free from unlawful influence, fraud, or duress.
2. Agent Representations: The Agent, by signing the formal acceptance below, warrants and represents that:
   • The Agent has reached the age of majority and is fully capable of managing sophisticated financial instruments and brokerage transactions;
   • The Agent is not currently subject to any civil, regulatory, or criminal judgment, bankruptcy proceeding, or sanctions list (e.g., OFAC) that would impair their capacity or legality to serve as a financial fiduciary;
   • The Agent will execute every instruction in compliance with state and federal securities laws, FINRA regulations, and the terms of this Power of Attorney.

SECTION 2.12: DISPUTE RESOLUTION AND ARBITRATION NOTICE

1. Incorporation of Brokerage Arbitration Clauses: The Principal and Agent expressly acknowledge that the Subject Accounts are bound by customer account agreements with Fidelity Brokerage Services LLC / National Financial Services LLC, which contain pre-dispute, binding arbitration clauses administered by the Financial Industry Regulatory Authority (FINRA) Dispute Resolution Services.
2. Mandatory FINRA Arbitration: Any controversy, claim, or dispute arising out of or relating to Fidelity's handling of the Subject Accounts, execution of orders, or enforcement of this Power of Attorney shall be resolved exclusively through final and binding arbitration administered by FINRA in accordance with its then-prevailing Code of Arbitration Procedure.
3. Disputes Between Principal and Agent: Any intra-party dispute, conflict, action for accounting, breach of fiduciary duty, or action for surcharge between the Principal (or the Principal’s legal representative/estate) and the Agent arising under this instrument shall be resolved exclusively in the state or probate court having jurisdiction over trusts and estates in the County and State specified in Section 2.13.

SECTION 2.13: GOVERNING LAW AND SEVERABILITY

1. Governing Law: This Power of Attorney shall be governed, construed, and enforced strictly in accordance with the internal substantive laws of the State of [Governing State / Jurisdiction], without giving effect to conflict of laws principles.
2. Severability: If any provision, sentence, clause, phrase, or word of this instrument or the application thereof to any person or circumstance is held to be invalid, illegal, or unenforceable by any court, administrative agency, or arbitral tribunal of competent jurisdiction, such invalidity shall not affect the remaining portions of this instrument. The remaining provisions shall continue in full force and effect, and this instrument shall be construed in all respects as if such invalid or unenforceable provision had never been incorporated herein.
3. Entire Agreement: This document constitutes the entire, integrated Power of Attorney authorization for the designated Fidelity accounts. It supersedes and cancels all prior discretionary brokerage authorization agreements, limited trading powers of attorney, or informal account agent access permissions previously granted to the Agent by the Principal with respect to the designated Subject Accounts, save and except for any statutory healthcare directives or broad general non-conflicting durable powers of attorney which shall operate complementarily.

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3. FORMAL SIGNATURE AND EXECUTION BLOCKS

IN WITNESS WHEREOF, the Principal has formally executed, sealed, and acknowledged this Institutional Durable Power of Attorney for Fidelity Accounts on this [Day] day of [Month], 20[Year].

FOR THE PRINCIPAL:

Signature: _____________________________________
Printed Name: [Principal Full Legal Name]
Principal Address: [Principal Street Address, City, State, Zip]
Date: [Execution Date]

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4. AGENT ACKNOWLEDGMENT AND ACCEPTANCE OF APPOINTMENT

I, [Agent Full Legal Name], the undersigned Agent, hereby accept the appointment as Attorney-in-Fact under the foregoing Durable Power of Attorney. I explicitly acknowledge, certify, and affirm that:

1. I have read, understand, and agree to be bound by the terms, limitations, and covenants set forth in this instrument.
2. I recognize that I am a fiduciary under law and owe a strict duty of loyalty, prudence, and good faith to the Principal.
3. I am bound by the customer agreements, rules, and arbitration clauses governing the Principal’s accounts at Fidelity Brokerage Services LLC and National Financial Services LLC.
4. I will segregate the Principal's assets from my own personal property and maintain full accounting records of all transactions.

FOR THE AGENT:

Signature: _____________________________________
Printed Name: [Agent Full Legal Name]
Title: Attorney-in-Fact / Agent
Date: [Agent Execution Date]

FOR THE SUCCESSOR AGENT (IF APPLICABLE):

Signature: _____________________________________
Printed Name: [Successor Agent Full Legal Name]
Title: Successor Attorney-in-Fact
Date: [Successor Agent Execution Date]

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5. ATTESTATION OF SUBSCRIBING WITNESSES

The foregoing instrument was on the date thereof signed, sealed, published, and declared by the Principal, [Principal Full Legal Name], to be their Durable Power of Attorney for Fidelity Accounts, in the presence of us, who, at the Principal’s request, in the Principal’s presence, and in the presence of each other, have subscribed our names as witnesses thereto, believing the Principal to be of sound mind, legal capacity, and acting free from duress, coercion, or undue influence.

WITNESS 1:

• Signature: _____________________________________
• Printed Full Name: [Witness 1 Full Legal Name]
• Residential Address: [Witness 1 Street Address]
• City, State, Zip Code: [Witness 1 City, State, Zip]
• Date: [Date]

WITNESS 2:

• Signature: _____________________________________
• Printed Full Name: [Witness 2 Full Legal Name]
• Residential Address: [Witness 2 Street Address]
• City, State, Zip Code: [Witness 2 City, State, Zip]
• Date: [Date]

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6. FORMAL NOTARY PUBLIC ACKNOWLEDGMENT

STATE OF [Governing State]
COUNTY OF [County of Notarization] , ss.

On this [Day] day of [Month], 20[Year], before me, the undersigned Notary Public, personally appeared [Principal Full Legal Name], known to me (or satisfactorily proven by presentation of valid government-issued photographic identification, namely [Type of ID, e.g., Driver's License / Passport]) to be the person whose name is subscribed to the within instrument, and acknowledged to me that they executed the same freely and voluntarily for the purposes and consideration therein expressed and contained.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official notarial seal the day and year first above written.

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Notary Public Signature

Printed Name: [Notary Public Printed Name]
My Commission Expires: [Commission Expiration Date]
Notary Registration Number: [Notary Registration Number]
(Affix Official Notarial Stamp/Seal Below)

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7. STEP-BY-STEP EXECUTION, VERIFICATION & FILING GUIDE

To guarantee that Fidelity Brokerage Services LLC ("FBS") and National Financial Services LLC ("NFS") accept this instrument without administrative rejection or processing delay, follow the institutional onboarding protocol outlined below:

                  STEP-BY-STEP WORKFLOW TO EXECUTION & ACCEPTANCE
  ┌───────────────────┐     ┌───────────────────┐     ┌───────────────────┐
  │ 1. Data Pop &     │ ──> │ 2. Physical       │ ──> │ 3. Notarization & │
  │    Customization  │     │    Execution      │     │    Two Witnesses  │
  └───────────────────┘     └───────────────────┘     └───────────────────┘
                                                                │
                                                                ▼
  ┌───────────────────┐     ┌───────────────────┐     ┌───────────────────┐
  │ 6. Verification & │ <── │ 5. Institutional  │ <── │ 4. Fidelity Form  │
  │    Trade Status   │     │    Submission     │     │    Reconciliation │
  └───────────────────┘     └───────────────────┘     └───────────────────┘

Step 1: Text Customization & Bracket Replacement

1. Open this document in an advanced text processor (Microsoft Word, Google Docs, or LibreOffice).
2. Use the Find and Replace utility to identify every bracketed item (e.g., [Principal Full Legal Name], [Fidelity Account Number 1], [Governing State / Jurisdiction]).
3. Accurately verify each Fidelity Brokerage Account Number against the official monthly statement or the online customer portal. If granting blanket authorization, ensure the checkbox in Section 1.4 is explicitly marked with an [X].
4. Ensure the optional provisions (Gifting in Section 2.05, Compensation in Section 2.06, and Springing vs. Immediate in Section 2.07) are definitively selected. Unselected alternatives should be stricken through or cleanly removed to prevent contractual ambiguity.

Step 2: Physical Signatory Verification and Protocol

• Electronic Signatures Warning: While many jurisdictions authorize electronic signatures under the Uniform Electronic Transactions Act (UETA) and the federal E-SIGN Act, Fidelity routinely rejects purely digital or self-signed e-signatures on third-party non-Fidelity Power of Attorney forms.
• Standard Requirement: Print the customized document on standard 8.5 x 11-inch white bond paper and execute it using a black or dark blue ink pen (wet signature).

Step 3: Formal Attestation and Notarization Session

1. The Principal must appear in person before a qualified, active Notary Public.
2. Two (2) Independent Adult Witnesses must be present at the exact time of signing. The witnesses:
   • Must not be the designated Agent, Alternate Agent, or related to the Agent by blood or marriage;
   • Must not be employees, executives, or registered representatives of Fidelity;
   • Must not be named as heirs, devisees, or beneficiaries of the Principal’s estate.
3. The Principal must sign Section 3 in the simultaneous presence of the Notary Public and the two witnesses.
4. The Agent must execute Section 4 (Agent Acceptance). While simultaneous execution is preferred, the Agent may sign in counterpart prior to submission.
5. The Notary must execute the Jurat/Acknowledgment block in Section 6, write in the expiration date and commission number, and affix an official embossed or ink seal.

Step 4: Cross-Referencing Fidelity Account Requirements

• Fidelity often requests their internal supplementary document titled "Fidelity Power of Attorney Affidavit" or "Certification of Attorney-in-Fact" if this outside institutional form is utilized.
• Have the Agent obtain, complete, and sign the Fidelity Certification of Attorney-in-Fact Form certifying that the Principal is still living and that the POA remains in full force.

Step 5: Submission to Fidelity Investments

Deliver the executed, notarized, and witnessed instrument to Fidelity using one of the following secure delivery methods:

1. Physical Branch Delivery (Recommended): Bring the original document (or a certified copy) directly to a local Fidelity Investments Investor Center. Request that a Fidelity branch associate review the document, stamp it received, verify the customer records, and transmit it directly through internal channels to the Legal Operations / Document Processing Department.
2. Secure Electronic Upload: If authorized within the Fidelity online portal:
   • Scan the fully executed document as an institutional-grade PDF (minimum 300 DPI, full color or clear grayscale).
   • Log into the Principal's or Agent's verified Fidelity account at www.fidelity.com.
   • Access Customer Service > Contact Us > Send a Secure Message / Upload Documents.
   • Attach the PDF document, identifying the submission as a "Power of Attorney Document Registration."
3. Certified Mail / Overnight Courier:
   • Regular Mail:
     Fidelity Investments
     ATTN: Power of Attorney / Legal Services Operations
     P.O. Box 770001
     Cincinnati, OH 45277-0002
   • Overnight Express (FedEx / UPS):
     Fidelity Investments
     ATTN: Power of Attorney / Legal Services Operations
     100 Crosby Parkway, Mailzone KC1N
     Covington, KY 41015

Step 6: Post-Submission Verification and Account Access

1. Allow three (3) to five (5) business days for Fidelity's Legal and Compliance Department to review the instrument.
2. The Principal or Agent should contact Fidelity Client Services at 1-800-544-6666 to verify that:
   • The POA has been approved and registered without deficiency;
   • The Agent has been assigned independent Authorized Agent login credentials (the Agent must never share or use the Principal's personal online password);
   • Trading and disbursement authorizations are updated across all targeted accounts.

Step 7: Record Retention

1. The Principal must retain the primary executed physical original with their core estate planning files (e.g., will, trust, health proxy).
2. The Agent must retain a true, certified duplicate copy ready for presentment in the event of any transactional dispute or emergency.
3. Keep a clear record of the tracking receipt or branch intake slip verifying the exact date Fidelity acknowledged receipt of the document.