EFTA01273264.pdf

San 01NUMMI ONV NOIS Signature Page Ghisialne Maxwell Account Number and Description Signature Requirement z By signing below and depositing cash or securities in my account, I acknowledge that I have read, understand and agree with the enclosed UBS Client Relationship Agreement, as well as the terms, conditions and disclosures in the Agreements and Disclosures booklet that I previously received, IRA Benefldary Designation Electronic Delivery Consent By signing below, I designate the beneficiary or beneficiaries that appear As you requested, we have sent your agreements and disclosure booklet on the enclosed Account information pages. and other account-related documents electronically to which we consider to be the e-mall address of Employer Retirement Plan Rollovers record or all owners of the account. The Information is also available at For fOlloVPIS born an employees retirement darn I have reviewed the www.ubs.com/accountdisdosures or by request to your financial Advisor. options available and evaluated the Investment and non-investment Scott Stedman I Lyle Cavielat 1.212-821.7000. considerations described in the IRA Rollover Disclosure avallabe In the Agreements and Disclosures booklet; I understand the fees and costs associated with IRA and I have made the decision to roll over my assets to a UBS IRA independently. I also understand that if UBS provides services to my employees retirement plan, none of the information provided to me by MIS or its employees about rolhng over to an IRA was provided as part of any existing fiduciary relationship to the plan under ERISA and that neither UBS nor its employees acted as an ERISA fiduciary in supplying such information. The Client Relationship Agreement contains a pre-dispute arbitration clause located in the final section under the title "Arbitration' PG "slainelMaxwell:On4pir„. p- s...ir,,y1T7.1a-c,ffa/SlalainieaatC .Ii1TriF For Accounts: Y1 23697 Traditional IRA - Sole Owner < I ti fly SIGN AND DATE MAL Date ta LzretzcTITTarTREEEMEZEMEWadeptillfgraltifiFairel&-rA 7, sElwarfelili;spfl'Ea1 -zetatiatlizid S9 6MT WalF,BZ 009463 955 Paget of 1 MINMIN Ylq 1111111110111 11111 SDNY_GM_00020436 CONFIDENTIAL 19 EFTA 00131056 EFTA01273264