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Outgoing International Bank Wire

This form will enable you to transfer foreign currency to a designated foreign beneficiary. U.S. dollars will be debited from your Fidelity
brokerage account and a current transaction rate applied, enabling you to deliver foreign funds to a foreign location. The U.S. dollars will
be debited from your brokerage core account on trade date and the foreign currency credited to the beneficiary’s receiving bank, as
indicated below, two business days following trade date. All foreign currency wire transfers are processed via SWIFT.
Please fill out Sections 1, 2 and 4 and ensure you obtain the appropriate authorization (Section 2) before contacting a Fidelity
Representative to initiate the foreign currency wire. Section 5 will be filled out by a Fidelity Representative and will represent the terms
of the foreign currency wire.
Return the completed form to a Fidelity Representative.

1 Owner Information

– –
Name of Account Owner Social Security Number

–
Name of Co-Owner (if any) Brokerage Account Number

2 Authorization
All account owners must sign below. Please have your signature(s) guaranteed. A signature guarantee is designed to protect you and Fidelity
from fraud. You should be able to obtain a signature guarantee from a bank, broker-dealer, credit union (if authorized under state law),
securities exchange or association, clearing agency, or savings association. A notary public cannot provide a signature guarantee. We cannot
accept a notarization instead of a signature guarantee.
I (We), the undersigned, hereby constitute and appoint Fidelity FOREX, Inc., and Fidelity Brokerage Services LLC (FBS) our true and lawful
attorney to surrender for redemption any and all shares or cash held in the above-indicated account, with full power of substitution in the
premises. Fidelity FOREX and FBS are hereby authorized and directed to accept and act upon directions for redemption of shares held in
the above account if Fidelity FOREX fails to receive currency under contract. I (We) understand and agree that Fidelity FOREX and FBS will
transmit the redemption proceeds to Fidelity FOREX’s bank account. I (We) understand and agree that Fidelity FOREX and FBS will not be
liable for any loss, expense, or cost arising out of any request for redemption so long as Fidelity FOREX and FBS transmit the redemption
proceeds to the bank account identified below. I (We) further certify and agree that these certifications, authorizations, and appointments
in this document will continue until Fidelity FOREX and FBS receive actual written notice of any change thereof.
Signature of Owner Date Signature guarantee stamp

Signature of Joint Owner Date Signature guarantee stamp

A notary public cannot provide a signature guarantee.



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 3 Receiving Bank for USDs
Bank: J.P. Morgan Chase Manhattan
Address: 4 New York Plaza, 15th Floor, New York, NY 10004
Beneficiary: Fidelity FOREX, Inc.
Account Number: 001047194
ABA Number: 021000021

4 Bank Information — please print

Receiving Bank of Foreign Currency

Bank Name IBAN (required for all EUR and GBP payments)

City Country Branch (required for all ZAR and JPY payments)

Swift Code (for all currencies) or Sort Code for GBP Other Requirements: AUD — BSB number, CAD — Transit number, INR — IFSC
Code, MXN — CLABE number

Any Additional Information

Intermediary Bank (if applicable) An intermediary bank is required only if the beneficiary does not maintain an account with the receiving bank.

Bank Name IBAN (required for all EUR and GBP payments)

City Country Branch (required for all ZAR and JPY payments)

Swift Code (for all currencies) or Sort Code for GBP Other Requirements: AUD — BSB number, CAD — Transit number, INR — IFSC
Code, MXN — CLABE number

Any Additional Information

Beneficiary at Receiving Bank for Foreign Currency

Name Account Number (where account is held)

City Country
You may experience a delay in the processing of your wire request due to the required compliance with governmental obligations under the U.S. federal laws.

5 Terms of Foreign Currency Wire

For Fidelity Use Only

Fidelity Representative

Phone # _Fax #

Fidelity Operations Contact _ Phone # _ Fax #

Transaction Information
CCY Currency Amount CCY Currency Amount

Client Buys Client Sells USD

Rate Value Date

Dollar Wire Transfer

Verified USDs available in Cactus (Y/N) Cactus Wire Disbursement No.

Reviewed Date     Time

456268.3.0 OUTBNK-FRM-0110
Fidelity Brokerage Services LLC, Member NYSE, SIPC 1.756307.106