Questions? Go to Fidelity.com/TransferMoneyShares or call 1-800-544-6666.

1.702030.105 Page 1 of 1 012240201

Certificate Release RequestUse this form to deposit a certificate into a Fidelity brokerage account when the name and registration on the certificate do not match the name and registration on the Fidelity account. Use one form per certificate to be deposited. Type on screen or fill in using CAPITAL let-ters and black ink. If you need more room for information or signatures, use a copy of the relevant page.

1. Account Owner Account Number Name

Evening Phone Daytime Phone Extension

2. Certificate Information Quantity of Shares Security Name Certificate Number Name(s) as Printed on Certificate

3. Signature(s) and Date(s) Current certificate holder(s) must sign and date.

By signing below, you:• Authorize Fidelity to accept the shares of the security indicated in Section 2 and deposit said security into the account of the owner(s) named

above. The owner(s) may, for all purposes whatsoever, be treated as the sole owner(s) of said security and any of the proceeds thereof. A Medallion signature guarantee is required.

If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can get a Medallion signature guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a signature guarantee.

Important: The signature(s) must match exactly, without alteration, the name(s) as printed on your certificate.

PRINT CERTIFICATE OWNER NAME MEDALLION SIGNATURE GUARANTEE

CERTIFICATE OWNER SIGNATURE

SIG

N

XTODAY’S DATE MM/DD/YYYY

DA

TE

XPRINT CERTIFICATE OWNER NAME MEDALLION SIGNATURE GUARANTEE

CERTIFICATE OWNER SIGNATURE

SIG

N

XTODAY’S DATE MM/DD/YYYY

DA

TE

X

Provide name(s) on receiving account.

Phone numbers may be used if we have

questions but will not be used to update your

account information.

Use a separate form for each certificate

to be deposited.

On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 157339.3.0 (10/15)

Did you print and sign the form? Send the ENTIRE form to Fidelity Investments.

Questions? Go to Fidelity.com or call 1-800-544-6666.

Use postage-paid envelope, drop off at a Fidelity Investor Center, OR deliver to:

Regular mail Fidelity Investments Attention: Banking Services P.O. Box 770001 Cincinnati, OH 45277-0002

Overnight mail Fidelity Investments Attention: Banking Services 100 Crosby Parkway KC1N Covington, KY 41015