Resident Beneficiary Agreement

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Fidelity ® Charitable Gift Fund

Pooled Income Fund Gift Agreement
and Beneficiary Designation Form
• To contribute securities or mutual funds held at a firm other than Fidelity®, the attached Letter of Instruction is required.
• To contribute cash, securities or mutual funds held in a non-retirement Fidelity brokerage account, please read Section 8 and disregard
  the attached Letter of Instruction.
• Please type or print clearly in all CAPITAL LETTERS using black ink.
 1 POOLED INCOME FUND (“PIF”) ACCOUNT HOLDER INFORMATION
    All Account Holders named on the Pooled Income Fund Account have full and equal privileges. There can be up to four Account
    Holders with one person serving as the Primary Pooled Income Fund Account Holder to whom all Pooled Income Fund Account
    correspondence will be sent, with the exception of confirmations related to contributions made by Additional Pooled Income
    Fund Account Holder(s). Attach additional sheets, if necessary.
    Primary PIF Account Holder (required)                                                           How would you like to be addressed
                                                                                                    (e.g., Dr. and Mrs. John A. Smith; Joan and John Smith, etc. This will appear on
    Name of Primary Account Holder (Prefix, First, Middle Initial, Last)                            Giving Account correspondence.)




    Social Security or Tax ID Number (TIN)                  Date of Birth (mm-dd-yyyy)

                  -          -                                         -        -
                                                                                                                           U.S. Citizen         U.S. Resident Alien

    Legal Address (P.O. boxes not accepted)                                                  Mailing Address (if different)



    City                         State      ZIP Code/Postal Code                             City                            State        ZIP Code/Postal Code

                                                                   -                                                                                             -
    Day Phone                                               Evening Phone                                               Email Address

                  -               -                                        -             -
    Additional PIF Account Holder (optional)
    Name of Additional Account Holder (Prefix, First, Middle Initial, Last)




    Social Security or Tax ID Number (TIN)                  Date of Birth or Trust (mm-dd-yyyy)

                  -          -                                         -        -
                                                                                                                           U.S. Citizen         U.S. Resident Alien

    Legal Address (P.O. boxes not accepted)                                                  Mailing Address (if different)



    City                         State      ZIP Code/Postal Code                             City                            State        ZIP Code/Postal Code

                                                                   -                                                                                             -
    Day Phone                                               Evening Phone                                               Email Address

                  -               -                                        -             -
 2 NAME YOUR POOLED INCOME FUND ACCOUNT (E.G., SMITH FAMILY FUND)
   Remainder distributions to charitable beneficiaries are accompanied by a letter that includes the Pooled Income Fund
   Account Name, unless anonymity is specifically requested.
    Pooled Income Fund Account Name




                  1.857147.103                                                                                                               018400101
3    ADVISOR INFORMATION
    If an advisor guided you in the decision to establish a Pooled Income Fund Account, please fill out the following section.
      Accountant           Estate planning attorney          Financial planner       Other:
    Advisor Name                                                                                          Firm Name




    Day Phone                                                                                             Email Address (optional)

                   -               -
    Mailing Address




    City                                                                                                  State       ZIP Code/Postal Code

                                                                                                                                              -
    – OR –

    Fidelity Representative                                                                               Name of Branch




4   INCOME BENEFICIARY INFORMATION
    You may select one or two people to receive the income generated by your account, which can include yourself (e.g., you and
    your spouse, you and your child, your spouse and your sibling, etc.). Income payments are made following each quarter. Income
    Beneficiary(ies), unless also named as an Account Holder in Section 1, do not have any other account privileges including changing
    charitable remainder beneficiary recommendations and obtaining account information.

    First Income Beneficiary (must be completed)
    Name of First Income Beneficiary (Prefix, First, Middle Initial, Last)                    Relationship to Account Holder




    Social Security or Tax ID Number (TIN)                    Date of Birth (mm-dd-yyyy)

                   -          -                                         -        -
                                                                                                                        U.S. Citizen         U.S. Resident Alien

    Legal Address (P.O. boxes not accepted)                                                   City                        State        ZIP Code/Postal Code

                                                                                                                                                              -
    Day Phone                                                 Evening Phone                                           Email Address

                   -               -                                         -             -

    Second Income Beneficiary (optional)
    Name of Second Income Beneficiary (Prefix, First, Middle Initial, Last)                   Relationship to Account Holder




    Social Security or Tax ID Number (TIN)                    Date of Birth (mm-dd-yyyy)

                   -          -                                         -        -
                                                                                                                        U.S. Citizen         U.S. Resident Alien

    Legal Address (P.O. boxes not accepted)                                                   City                        State        ZIP Code/Postal Code

                                                                                                                                                              -
    Day Phone                                                 Evening Phone                                           Email Address

                   -               -                                         -             -




                   1.857147.103                                                                                                           018400102
4   INCOME BENEFICIARY INFORMATION (continued)
    If there is more than one income beneficiary, choose and complete one of the following:
         Concurrent Income Beneficiaries:
         The FIRST Income Beneficiary will receive            % of the income from my/our fund and The SECOND Income
         Beneficiary will receive           % of the income from my/our fund as Concurrent Income Beneficiaries for their joint lives;
         thereafter, all income will go to the surviving beneficiary during his or her lifetime.
         Percentages do not have to be equal to each other, but must total 100%.

    OR

         Consecutive Income Beneficiaries:
         All income from my/our gift will be distributed to:
         The FIRST Income Beneficiary for his or her lifetime, and then to The SECOND Income Beneficiary for his or her lifetime.
         Please note: If the Second Income Beneficiary is a non-spouse and you designate yourself to be the First Income Beneficiary, you
         may reserve the right to revoke the income interest of the Successor Beneficiary through your will. Failure to reserve this right will
         cause you to make a gift for federal gift tax purposes of the value of the Successor Beneficiary’s future income interest, which may
         be taxable to your estate.
         It is highly recommended that, if you need to reduce your gift or estate tax liability, you reserve the right to revoke by signing
         the statement below:

         Account Holder 1 Signature                                            Account Holder 2 Signature




         Please note: The signature(s) required in this section refers to the person(s) making contributions to this account.

5   DIRECT DEPOSIT INSTRUCTIONS


     John Doe                                          To ensure accuracy, please enclose a voided check or fill
     61 Maple St.
     Anytown, MA 00000                                 out the information below.
     PAY TO THE
     ORDER OF
                  VOID                   $
                                             Dollars
                                                         Bank Account:
    First National Bank
    One Main Street, Anytown, MA 00000                   Bank Name:
    910002010 509779195      701

                                                         Nine-Digit Routing Number:
   NINE-DIGIT             CHECK NUMBER
ROUTING NUMBER            DO NOT INCLUDE
            ACCOUNT NUMBER                               Checking or Savings Account Number:
             (UP TO 17 DIGITS)
                                                         Fidelity Account:

                                                         Account Number:




                  1.857147.103                                                                                  018400103
6   IRREVOCABLE CONTRIBUTION ($20,000 MINIMUM INITIAL GIFT)
    Please complete the applicable section below.

    A. CONTRIBUTE CASH EQUIVALENTS:
    Please note: The Pooled Income Fund will not accept contributions of currency or certain cash-like monetary instruments, including cashier’s
    checks, treasurer’s checks, bank checks, bank drafts, traveler’s checks, postal money orders, or money orders.


        CHECK: $                                                               WIRE: $
        Checks may reference a specific Pooled Income Fund
        Account number or name, but must be made payable to                    BAN K:
        Fidelity® Charitable Gift Fund Pooled Income Fund. Mail
        check(s) with completed Gift Agreement and Beneficiary                  Wire to: JPMorgan Chase Bank, New York, NY
        Designation Form.                                                      ABA Number: 021000021
                                                                               For credit to: National Financial Services LLC
                                                                               Account: 066196-221
                                                                                                                      -
                                                                               For benefit of: Pooled Income Fund. Z99-042218
                                                                               The Pooled Income Fund will not initiate this wire transfer.

    B. CONTRIBUTE CASH, SECURITIES OR MUTUAL FUNDS HELD AT FIDELITY INVESTMENTS®:
    Please note: All trades are transacted in shares. If you prefer to indicate a dollar amount, we will make a current estimate
    (based on the previous business day’s closing share price) of the number of shares needed to reach the dollar amount
    indicated. However, the amount may be above or below the dollar amount you indicated due to market conditions at the close of the
    market on the day the transaction is processed.


        CASH HELD AT FIDELITY                                                  MUTUAL FUND/SECURITY
    Please Transfer                                                        Name of Mutual Fund/Security (and symbol, if known)

    $

    Fidelity Account Number                                                Fidelity Account Number                Name on Fidelity Account



                                                                           Number of Shares



                                                                           Approximate Dollar Amount (optional)

                                                                           $                                                       ($20,000 minimum)


    C. CONTRIBUTE SECURITIES OR MUTUAL FUNDS HELD AT A FIRM OTHER THAN FIDELITY INVESTMENTS:

    A completed Letter of Instruction is required. Please refer to the attached Letter of Instruction Form for mailing instructions.

    D. CONTRIBUTE STOCK CERTIFICATES HELD IN PERSONAL POSSESSION:

    Name of Stock                              Number of Shares           Name of Stock                                   Number of Shares




    Endorse certificate(s) by writing “National Financial Services LLC” between the words “appoint” and “attorney” in the space
    provided on the back of each certificate. Date and sign the certificate exactly as your name(s) appears on the front, and obtain
    a Medallion Signature Guarantee at a Fidelity Investor Center or other financial institution that participates in the Medallion
    Signature Guarantee Program. Please note, a notary stamp is not a Medallion Signature Guarantee. Mail certificates along with this
    application via registered mail.




                  1.857147.103                                                                                    018400104
7   BENEFICIARY RECOMMENDATION
    Upon the death(s) of the income beneficiary(ies), the value of units attributable to your gift to the Pooled Income
    Fund (the “remainder interest”) will be distributed to the Fidelity ® Charitable Gift Fund. You, as the Pooled Income
    Fund Account Holder, may at any time during your life request that the Gift Fund make immediate grant distribu-
    tions to other charitable organizations, establish a Giving Account ® at the Gift Fund, or a combination of both. Total successor
    allocation among the options must be 100%. If no recommendation is made, upon the death(s) of the income beneficiary(ies), any
    remainder interest will be distributed to the Fidelity ® Charitable Gift Fund (“Gift Fund”) Trustees’ Philanthropy Fund. If you wish to
    make changes in the future, you may do so by notifying the Pooled Income Fund in writing.

    A. DISTRIBUTIONS TO CHARITABLE ORGANIZATIONS OTHER THAN THE GIFT FUND:

    Pooled Income Fund Account Holders may recommend the distribution of the remaining interest to a maximum of 10 IRS-
    qualified public charities. Pooled Income Fund Account Holders may make this recommendation at any time during their lives
    by completing the following section, then signing and sending this form to the Pooled Income Fund. All recommendations are
    subject to the review and approval of the Trustees of the Fidelity® Charitable Gift Fund.
    Please attach another sheet to make additional recommendations, if necessary.

    Charitable Remainder Beneficiary #1
                                                                                                                                   % OF PIF
    Organization Name                                                    Federal Tax ID Number (if applicable)                    ACCOUNT

                                                                                                                                          %

    Mailing Address                                                      Phone

                                                                                       -               -

    City                   State    ZIP Code/Postal Code                 Special Purpose (e.g., in memory of, etc.)

                                                           -

    Charitable Remainder Beneficiary #2
                                                                                                                                   % OF PIF
    Organization Name                                                    Federal Tax ID Number (if applicable)                    ACCOUNT

                                                                                                                                          %




    Mailing Address                                                      Phone

                                                                                       -               -

    City                   State    ZIP Code/Postal Code                 Special Purpose (e.g., in memory of, etc.)

                                                           -
    Tax deductions discussed herein refer specifically to federal taxes. Rules and regulations regarding tax deductions for charitable giving
    vary at the state level. Please check with your tax advisor.
    B. ESTABLISH A GIVING ACCOUNT® AT THE FIDELITY® CHARITABLE GIFT FUND:

    Complete this section to establish a Giving Account for an Individual. PIF Account Holders may request that the Gift Fund establish and
    maintain a Successor Giving Account with the remainder interest at their death. PIF Account Holders may name individuals who will
    assume all Giving Account privileges (such as overseeing contributions and making grant recommendations) upon the death of the PIF
    Account Holder. Your designated Successor may recommend grant distributions to IRS-qualified public charities. Upon your death, the
    Gift Fund will send the individual Successor named below the Gift Fund’s Program Circular and Donor Application.




                 1.857147.103                                                                                         018400105
7   BENEFICIARY RECOMMENDATION (continued)
    Please note: Upon the death of the last income beneficiary, any remainder interest is subject to the terms and conditions
    set forth by the Fidelity® Charitable Gift Fund.

    Successor                                                                Relationship to PIF Account Holder




    Social Security Number                                                   Date of Birth (mm-dd-yyyy)

                  -          -                                                        -          -

    Legal Address (P.O. boxes not accepted)                                  Day Phone

                                                                                          -               -

    City                         State    ZIP Code/Postal Code               Evening Phone
                                                                 -                        -               -

    Mailing Address (if different)                                           Email Address




    City                         State    ZIP Code/Postal Code

                                                                 -
                                                                                  U.S. Citizen        U.S. Resident Alien

8   FIDELITY BROKERAGE CUSTOMERS ONLY

           By checking this box:
    You (an account owner of a Fidelity brokerage account) are 1) authorizing National Charitable Services Corp. (“NCS”) to accept
    instructions from You and/or your authorized Interested Party/Agent/Advisor (“Your Agent”) to transfer cash and securities from
    a Fidelity non-retirement brokerage account to the Fidelity® Charitable Gift Fund Pooled Income Fund, as a charitable contribu-
    tion, without requiring additional written instructions from You; and 2) authorizing Fidelity Brokerage Services LLC and National
    Financial Services LLC to act on such instructions directly from NCS without additional authorizations from You. This authorization
    shall apply only to non-retirement Fidelity brokerage accounts on which You are registered as an owner (“Fidelity Account”), and in the
    case of Your Agent, for which Your Agent has been authorized with full trading authority or asset movement authorization level 1
    or 2. This authorization will only be relied upon when You or Your Agent provides contribution instructions to the Pooled Income
    Fund. This authorization is subject to the terms and conditions described below. Please read these terms and conditions carefully
    and retain them for your records.

    Terms and Conditions
    By granting this authorization, You understand and agree that Fidelity Brokerage Services LLC, National Financial Services LLC, and
    National Charitable Services Corp. (collectively hereinafter “Fidelity”), and the Fidelity® Charitable Gift Fund (“Gift Fund”) Pooled
    Income Fund will not undertake to confirm Your Agent’s representations or instructions or to monitor Your Agent’s compliance with
    your instructions to him or her and will rely solely upon the instructions of Your Agent for these transfers. You understand that You
    should carefully review your account documentation and monitor all activity in your Fidelity Account and your Pooled Income Fund
    Account at the Gift Fund. Fidelity or NCS may require direct instructions from You on transactions over a certain dollar amount.
    Upon requests for any account-related activity in your Fidelity Account or your Pooled Income Fund Account at the Gift Fund from
    Your Agent, Fidelity and/or the Gift Fund reserves the right, but is not obligated, to confirm with You any of your or Your Agent’s
    instructions prior to acting on them and to restrict or not accept requests for these transfers, at its/their own discretion. Your Agent
    is authorized to act for You and on your behalf in the same manner and with the same force and effect as you might or could do
    to the extent necessary or incidental to the furtherance or conduct of the Fidelity Account in accordance with this authorization or
    your separate standing instructions. Your Agent will not conduct activity in your Fidelity Account that exceeds its authority under
    this authorization or any other agreement governing your Fidelity Account(s). This authorization shall be applicable to all assets you
    hold in your Fidelity Account(s). No Fidelity entities are affiliated with Your Agent (excluding however, Strategic Advisers, Inc.) and
    have no relationship except as described in this authorization. Neither Fidelity nor the Gift Fund will have any duty to inquire into
    the authority of Your Agent to engage in particular transactions or to monitor the terms of any oral or written agreement between
    You and Your Agent. Your Agent is obligated to comply with, and make all disclosures as required by, all applicable state, Federal




                   1.857147.103                                                                                   018400106
8   FIDELITY BROKERAGE CUSTOMERS ONLY (continued)
    and industry securities laws and regulations, and interpretations promulgated there under, including but not lim-
    ited to the Investment Advisers Act of 1940, the Securities Exchange Act of 1934, the Investment Company Act
    of 1940 and the NASD Rules and/or FINRA rules. Neither Fidelity nor the Gift Fund will undertake to confirm or
    ensure that Your Agent remains in compliance with its obligations. You agree to indemnify and hold harmless Fidelity Brokerage
    Services LLC, National Financial Services LLC, National Charitable Services Corp., and the Fidelity® Charitable Gift Fund Pooled
    Income Fund, and any of its affiliates and their respective officers, directors, employees and agents from and against any and all
    losses, claims or financial obligations (including reasonable attorneys’ fees) that may arise from any act or omission of Your Agent
    with respect to your Fidelity Account or Pooled Income Fund account at the Gift Fund. This authorization is a continuing one and
    shall remain in full force and effect until either Fidelity or the Gift Fund is notified in writing of your death, disability or incapac-
    ity or unless revoked through written notice actually received by either Fidelity or the Gift Fund. Such revocation, however, shall
    not affect any prior liability in any way resulting from any transaction initiated before receipt of the revocation. Furthermore, it is
    understood that this authorization and indemnity is in addition to, and in no way restricts, any rights that may exist at law or under
    any other agreement(s) between You and Fidelity Brokerage Services LLC, National Financial Services LLC, National Charitable
    Services Corp., or the Fidelity® Charitable Gift Fund Pooled Income Fund. This authorization and indemnity shall be construed,
    administered and enforced according to the laws of the Commonwealth of Massachusetts. It shall inure to the benefit of Fidelity and
    the Gift Fund, and of any successor organization(s) (whether by merger, consolidation or otherwise) irrespective of any change(s) at
    any time in the personnel thereto for any cause whatsoever and to the benefit of the affiliates and the assigns of Fidelity or the Gift
    Fund or any successor organization. It is further understood that Fidelity and/or the Gift Fund reserves the right to cease accepting
    instructions from You or Your Agent at its sole discretion and for its sole protection.

9   SIGNATURE(S)
    I/We acknowledge I/we have read the current Disclosure Statement and Declaration of Trust and agree to the terms and/or condi-
    tions described therein. I/We understand any contribution, once accepted by the Trustees, represents an irrevocable contribution to the
    Pooled Income Fund and is not refundable to me/us. I/We hereby certify, to the best of my/our knowledge, all information presented
    in connection with this application is accurate and I/we will promptly notify the Pooled Income Fund in writing of any changes.
    I/We hereby irrevocably transfer to the Trustees of the Fidelity® Charitable Gift Fund (“Gift Fund”) Pooled Income Fund
    the property described in Section 6. This property is to be held, managed, and distributed according to the terms of the Declaration
    of Trust between Fidelity® Charitable Gift Fund and the Pooled Income Fund’s Trustees dated November 23, 1994 (“Declaration of
    Trust”) and this Gift Agreement and Beneficiary Designation Form (“Gift Agreement”). As required by the Declaration of Trust, the
    Trustees and I/we agree to the following:
    1. It is my/our intention that this gift qualify as a gift to a pooled income fund as defined in Section 642(c)(5) of the Internal Revenue
       Code of 1986, as amended from time to time, and this Gift Agreement shall be interpreted accordingly.
    2. I/We declare that the contribution described in this Gift Agreement is irrevocable and is not subject to amendment or modifica-
       tion by me/us other than by the optional right to revoke by will the income interest of any beneficiary as specified at the end of this
       Gift Agreement. (As described in the Disclosure Statement, your gift to the Fidelity® Charitable Gift Fund Pooled Income Fund is
       irrevocable — you cannot sell units in the Pooled Income Fund, borrow against them, or assign them to anyone.)
    3. Any additional contributions that I/we may make from time to time to the Trustees of the Pooled Income Fund that are accepted
       by them and that are specified to be governed by this Gift Agreement will not necessitate that an additional Gift Agreement be
       signed and delivered.
    4. If any gift, succession, inheritance, estate, or generation-skipping tax is assessed on my/our contributions to the Pooled Income
       Fund or any income interest related to my/our gift, I/we agree on behalf of myself/ourselves and my/our heirs, legal representatives,
       successors, and assigns to arrange for payment of this tax out of a source other than the Pooled Income Fund and to indemnify
       the Trustees from any and all liability for such tax.
    5. Upon termination of the interests of the income beneficiaries, the units of the Pooled Income Fund representing their interests
       will be separated from the Pooled Income Fund and transferred to the Trustees of the Fidelity® Charitable Gift Fund in accor-
       dance with the Declaration of Trust.




                1.857147.103                                                                                018400107
 9   SIGNATURE(S) (continued)
     6. I/We represent and warrant that the information provided in this Gift Agreement is true and correct and will indem-
        nify the Pooled Income Fund against any losses it may suffer due to any misrepresentations, breach or failure of
        such representations.
     7. I/We acknowledge that, before making this transfer, I/we have read the Disclosure Statement and Declaration of
        Trust describing the Pooled Income Fund.

     Primary Pooled Income Fund Account Holder Signature       Date              Additional Pooled Income Fund Account Holder Signature          Date




 Under policies of the Fidelity® Charitable Gift Fund, and in accordance with the anti-money laundering regulations applicable to the
 various financial institutions that provide financial services to the Fidelity® Charitable Gift Fund, we obtain, record, and may verify
 information that identifies each person who establishes a Pooled Income Fund Account at the Gift Fund and other people who
 contribute to the Pooled Income Fund or have access to the Pooled Income Fund Account.
 Therefore, when you establish a Pooled Income Fund Account, we will ask for the name, address, date of birth, and other information
 that will allow us to identify people with access to the Pooled Income Fund Account. We may also ask to see individual driver’s licenses
 or other identifying documents, and we may verify the information we obtain.




PLEASE MAIL COMPLETED APPLICATION ALONG WITH ANY DOCUMENTS SPECIFIED TO ONE OF THE ADDRESSES BELOW:
Regular mail address:                                           Overnight delivery address:
Pooled Income Fund                                              Pooled Income Fund
c/o Fidelity® Charitable Gift Fund                              c/o Fidelity® Charitable Gift Fund
P.O. Box 770001                                                 100 Crosby Parkway
Cincinnati, OH 45277-0053                                       Mail zone KC1D-FCS
Fax: 877-665-4274                                               Covington, KY 41015-9325

The Pooled Income Fund is a program of the Fidelity ® Charitable Gift Fund (“Gift Fund”), an independent public charity. Various Fidelity companies
provide investment management and administrative services to the Gift Fund. The Charitable Gift Fund logo is a service mark, and Giving Account ® is a
registered service mark, of the Trustees of the Fidelity Investments ® Charitable Gift Fund. Fidelity and Fidelity Investments are registered service marks
of FMR LLC, used by the Gift Fund under license.


559243.1.0                                                                                                                            PIF-GABD/LOI-1010




                  1.857147.103                                                                                         018400108
Fidelity® Charitable Gift Fund
Mutual Funds and Securities held at a firm other than Fidelity Investments®


Pooled Income Fund Letter of Instruction
When completing this form, please type or print clearly in all CAPITAL LETTERS using black ink.
Regular mail address:                                                       Overnight delivery address:
Pooled Income Fund                                                          Pooled Income Fund
c/o Fidelity® Charitable Gift Fund                                          c/o Fidelity® Charitable Gift Fund
P.O. Box 770001                                                             100 Crosby Parkway
Cincinnati, OH 45277-0053                                                   Mail zone KC1D-FCS
                                                                            Covington, KY 41015-9325
Phone: 800-952-4438 for assistance with any matter
Fax:      877-665-4274
Web:      CharitableGift.org for additional forms
A Letter of Instruction is required ONLY if you are transferring securities or mutual funds held at a firm other than Fidelity®.
If you are transferring cash, please refer to the instructions on the Pooled Income Fund Gift Agreement and Beneficiary
Designation Form or Pooled Income Fund Additional Gift Agreement Form.
1. Please complete the Letter of Instruction (which appears on the reverse side). All parties who are registered on the delivering
   firm’s account(s) must sign the letter.
2. Submit documentation according to the following instructions:
FOR MUTUAL FUNDS HELD AT A FIRM OTHER THAN FIDELITY
Mail to the Pooled Income Fund:
• Original Letter of Instruction; must be Medallion Signature Guaranteed.
  A Medallion Signature Guarantee can be obtained at any Fidelity Investor Center or other financial institution that participates
  in the Medallion Signature Guarantee Program. Please note, a notary is not a Medallion Signature Guarantee.
• Copy of a recent statement from the transferring mutual fund company.
• Pooled Income Fund Gift Agreement and Beneficiary Designation Form or Pooled Income Fund Additional Gift
  Agreement Form.

Do not send anything to the transferring mutual fund company.
FOR STOCKS HELD AT A FIRM OTHER THAN FIDELITY
Mail to the firm currently holding the securities:
• Original Letter of Instruction
  The firm holding the securities may require a Medallion Signature Guarantee, which can be obtained at any Fidelity Investor
  Center or other financial institution that participates in the Medallion Signature Guarantee Program. Please note, a notary is
  not a Medallion Signature Guarantee.
     AND
Mail or fax to the Pooled Income Fund:
• Copy of the Letter of Instruction.
• Pooled Income Fund Gift Agreement and Beneficiary Designation Form or Pooled Income Fund Additional Gift Agreement Form.
FOR DIVIDEND REINVESTMENT PLANS (DRIPs)
Call the Gift Fund at 800-952-4438 for instructions.
The Pooled Income Fund is a program of the Fidelity® Charitable Gift Fund (“Gift Fund”), an independent public charity. Various Fidelity companies provide
investment management and administrative services to the Gift Fund. The Charitable Gift Fund logo is a service mark of the Trustees of the Fidelity Invest-
ments® Charitable Gift Fund. Fidelity and Fidelity Investments are registered service marks of FMR LLC, used by the Gift Fund under license.




                1.857147.103                                                                                            018260101
 DONOR INSTRUCTIONS

Complete and deliver this Letter of Instruction as follows:
Mutual Funds (2–4 weeks to complete transfer from receipt of instructions): Mail original Medallion Signature
Guaranteed letter along with mutual fund statement and completed Pooled Income Fund Gift Agreement and
Beneficiary Designation Form or Pooled Income Fund Additional Gift Agreement Form to the Pooled Income Fund.
Securities: Mail original letter to delivering broker and mail or fax a copy along with a completed Pooled Income Fund Gift Agreement
and Beneficiary Designation Form or Pooled Income Fund Additional Gift Agreement Form to the Pooled Income Fund. If shares are
part of a DRIP, please call the Pooled Income Fund at 800-952-4438 for instructions.
Delivering Broker’s Firm                                                  Date                                   Daytime Phone

                                                                                   -           -                               -               -
Mailing Address




City                                                                                               State          ZIP Code/Postal Code

                                                                                                                                          -

Dear                                                                       :
                                    Broker’s Name

Please accept this letter as my authorization to irrevocably transfer the following positions from my
account with your firm to the Fidelity ® Charitable Gift Fund Pooled Income Fund .
FROM:                                                                            TO:
                               Outside Firm Account Number                             Pooled Income Fund Account Number (if known)
                                                                                       Note to Brokers/Dealers — This account number is not the valid delivery
                                                                                       brokerage account. See the Broker/Dealer Instructions section below.

1.                                       SHARES ($                                     ) OF
                      Number                          Approx. Dollar Amt. (if known)                             Mutual Fund Name or Security

2.                                       SHARES ($                                     ) OF
                      Number                          Approx. Dollar Amt. (if known)                             Mutual Fund Name or Security

3.                                       SHARES ($                                     ) OF
                      Number                          Approx. Dollar Amt. (if known)                             Mutual Fund Name or Security

Sincerely,
Signature

                                                                                                                REQUIRED
                                                                               PLACE MEDALLION SIGNATURE GUARANTEE PROGRAM STAMP HERE
Name (Please Print)




Signature



                                                                               Signature Guarantee                                                 Date
Name (Please Print)




 BROKER/DEALER INSTRUCTIONS
Deliver all eligible securities per these instructions. Shares should be transferred in-kind and are not to be liquidated.
For credit to: National Financial Services LLC                For benefit of: Fidelity® Charitable Gift Fund Pooled Income Fund
DTC: 226                                                      For further credit to: [Account Holder Name and PIF account number, if known.]
                    -
Account Number: Z97– 000442
Any physical deliveries (i.e., certificates) should be sent via registered mail to:
Pooled Income Fund, c/o Fidelity® Charitable Gift Fund, 100 Crosby Parkway, Mail zone KC1D-FCS, Covington, KY 41015-9325
559243.1.0                                                                                                                                     PIF-GABD/LOI-1010

                  1.857147.103                                                                                             018260102

				
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Description: Resident Beneficiary Agreement document sample