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54.165.246.140  Public Scan

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Submitted URL: https://na6504.customervoice360.com/uc/admin/6282/?code=cc20bb677a4c0344
Effective URL: https://na6504.customervoice360.com/uc/admin/6282/ospe.php?SES=607a0e94539897b5ddcb50671d34d326
Submission: On December 30 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

Name: f1 — POST ospe.php?SES=607a0e94539897b5ddcb50671d34d326

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  <h1 class="aria-heading">Tivian Survey Questionnaire</h1>
  <div class="container-wrap">
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          <h2 class="title mb-1">
            <center><strong>My Fidelity Innovations forum Winner Acceptance Form</strong></center><br><br>
            <p style="background-color: #dfffff;">IMPORTANT: <font style="font-weight: normal;">Please make sure to fill out all pages of this form and click 'submit' on the final page.</font> You must submit this completed form by the date indicated
              in the email you received along with the link to this form. <font style="font-weight: normal;">Otherwise the prize will be forfeited and awarded to an alternate winner.</font>
            </p>
            <br><br> Before we can award this prize, please ensure that you agree with each element of the following statements:<br><br>
            <font style="font-weight: normal;">I, the Selected Entrant, in consideration of being selected as Selected Entrant, and in consideration of receiving the prize described above, hereby:</font><br><br>
            <ol style="font-weight: normal;">
              <li>declare that I have complied with the sweepstakes rules and hereby reaffirm my agreement to be bound by them;<br><br></li>
              <li>confirm that I am a resident of the United States and I have reached the age of majority for the state in which I reside, and that neither I nor any member of my immediate family (or persons with whom they share a residence with) is
                an employee of <strong>Ipsos, Fidelity Investments</strong>&nbsp;or any of their affiliates;<br><br></li>
              <li>agree to the use of my name, address, and/or photograph in any publicity pertaining to this contest without payment or compensation; and<br><br></li>
              <li>release and hold harmless <strong>Ipsos, Fidelity Investments</strong>&nbsp;and any of their affiliates and agents, from any claims I may have with respect to this contest or the prize to be awarded to me and all liability, losses,
                damages and expenses which I may suffer or incur in connection with any claim, action, or proceedings or in any other manner related to the contest/sweepstakes, other than to provide me with the prize I may win.</li>
            </ol><br><br><span id="err1" style="display: none; color: red; font-weight: normal;">To claim your prize, you must accept the above terms and conditions. You may change your selection below, otherwise click "Next" to forfeit your
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              aria-label="My Fidelity Innovations forum Winner Acceptance Form
IMPORTANT: Please make sure to fill out all pages of this form and click 'submit' on the final page. You must submit this completed form by the date indicated in the email you received along with the link to this form. Otherwise the prize will be forfeited and awarded to an alternate winner.
 Before we can award this prize, please ensure that you agree with each element of the following statements: I, the Selected Entrant, in consideration of being selected as Selected Entrant, and in consideration of receiving the prize described above, hereby:
declare that I have complied with the sweepstakes rules and hereby reaffirm my agreement to be bound by them;
confirm that I am a resident of the United States and I have reached the age of majority for the state in which I reside, and that neither I nor any member of my immediate family (or persons with whom they share a residence with) is an employee of Ipsos, Fidelity Investments&nbsp;or any of their affiliates;
agree to the use of my name, address, and/or photograph in any publicity pertaining to this contest without payment or compensation; and
release and hold harmless Ipsos, Fidelity Investments&nbsp;and any of their affiliates and agents, from any claims I may have with respect to this contest or the prize to be awarded to me and all liability, losses, damages and expenses which I may suffer or incur in connection with any claim, action, or proceedings or in any other manner related to the contest/sweepstakes, other than to provide me with the prize I may win.
To claim your prize, you must accept the above terms and conditions. You may change your selection below, otherwise click &quot;Next&quot; to forfeit your prize. By selecting this option, you are forfeiting the prize. You may change your selection below, otherwise click &quot;Next&quot; to forfeit your prize."
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                      to forfeit my prize for some other reason.<br><span id="msg2" style="display: none; color: red; font-weight: normal;">Please let us know why you are forfieting the prize.</span></span><span
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Text Content

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TIVIAN SURVEY QUESTIONNAIRE

Progress: 19%


MY FIDELITY INNOVATIONS FORUM WINNER ACCEPTANCE FORM



IMPORTANT: PLEASE MAKE SURE TO FILL OUT ALL PAGES OF THIS FORM AND CLICK
'SUBMIT' ON THE FINAL PAGE. YOU MUST SUBMIT THIS COMPLETED FORM BY THE DATE
INDICATED IN THE EMAIL YOU RECEIVED ALONG WITH THE LINK TO THIS FORM. OTHERWISE
THE PRIZE WILL BE FORFEITED AND AWARDED TO AN ALTERNATE WINNER.



BEFORE WE CAN AWARD THIS PRIZE, PLEASE ENSURE THAT YOU AGREE WITH EACH ELEMENT
OF THE FOLLOWING STATEMENTS:

I, THE SELECTED ENTRANT, IN CONSIDERATION OF BEING SELECTED AS SELECTED ENTRANT,
AND IN CONSIDERATION OF RECEIVING THE PRIZE DESCRIBED ABOVE, HEREBY:


 1. DECLARE THAT I HAVE COMPLIED WITH THE SWEEPSTAKES RULES AND HEREBY REAFFIRM
    MY AGREEMENT TO BE BOUND BY THEM;
    
    
 2. CONFIRM THAT I AM A RESIDENT OF THE UNITED STATES AND I HAVE REACHED THE AGE
    OF MAJORITY FOR THE STATE IN WHICH I RESIDE, AND THAT NEITHER I NOR ANY
    MEMBER OF MY IMMEDIATE FAMILY (OR PERSONS WITH WHOM THEY SHARE A RESIDENCE
    WITH) IS AN EMPLOYEE OF IPSOS, FIDELITY INVESTMENTS OR ANY OF THEIR
    AFFILIATES;
    
    
 3. AGREE TO THE USE OF MY NAME, ADDRESS, AND/OR PHOTOGRAPH IN ANY PUBLICITY
    PERTAINING TO THIS CONTEST WITHOUT PAYMENT OR COMPENSATION; AND
    
    
 4. RELEASE AND HOLD HARMLESS IPSOS, FIDELITY INVESTMENTS AND ANY OF THEIR
    AFFILIATES AND AGENTS, FROM ANY CLAIMS I MAY HAVE WITH RESPECT TO THIS
    CONTEST OR THE PRIZE TO BE AWARDED TO ME AND ALL LIABILITY, LOSSES, DAMAGES
    AND EXPENSES WHICH I MAY SUFFER OR INCUR IN CONNECTION WITH ANY CLAIM,
    ACTION, OR PROCEEDINGS OR IN ANY OTHER MANNER RELATED TO THE
    CONTEST/SWEEPSTAKES, OTHER THAN TO PROVIDE ME WITH THE PRIZE I MAY WIN.



TO CLAIM YOUR PRIZE, YOU MUST ACCEPT THE ABOVE TERMS AND CONDITIONS. YOU MAY
CHANGE YOUR SELECTION BELOW, OTHERWISE CLICK "NEXT" TO FORFEIT YOUR PRIZE. BY
SELECTING THIS OPTION, YOU ARE FORFEITING THE PRIZE. YOU MAY CHANGE YOUR
SELECTION BELOW, OTHERWISE CLICK "NEXT" TO FORFEIT YOUR PRIZE.

 * Yes, I agree and I accept the prize
 * No, I do not agree and I do not accept the prize
   Please let us know why you do not accept the prize.
 * I would like to forfeit my prize for some other reason.
   Please let us know why you are forfieting the prize.



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