EFTA00237182.pdf

Investor Application Form (continued) NFA Bylaw 1101 Certification (Neese moral as appropriate. Individual. IRA and Foundation Investors: sc• snynstc: :flair:8 3'4 ewer ar tr. :he is an thAvidual. IRA Or a therdiitco mid that it is not INdrIK110 menthe' at the hatemat iusaes ASticeadironi- NFAl or to td 11* drieed nth the Consrrakty runies Tramp Ccanrmvon — Crtri <wanly ~Se <rent. cin to Seetc Inetsay Art fee4~1) OP 14 Other Entity lownlon: Inc nreckgg ror. rt Vw nonce it a (Carnality POOL the %Mat& Cheese!: reOrMeets and warrants it n not rep~ la be a ~Pr fli !he 1FA w to be •fyit'Ofhli or (ref': as h s' isoesei Mate Meat while net always the one. generally. certain private investment vehicle suds as 'ogle member limited ~tits; <canpan•es and certain bender/ partnerships comprised of family members. among other. shotdd Iniuel this sectors and below it appleraMes) tr the ~or n • hod or amen« twinned entry and milord irer BIC shave. Men compete the teltnier; the Innedorn•Imedy esiestment "CV VOL2Sa partarmants sn ide Only IllOuSti. thicken. m.Åws. giarouwents rod rhelee a tie enesva R • /any of14/ e and has Wed a nowt saiPi the CFTC under No-Action Letter 12-37 the Mesta Men miOn an mernoton Horn mgslraleari under Cf :C Rje I 13 and has Ned a home cumin; ism smeremtonsrenh the NSA the wealth hem uson an ezetuteon Iron try ~bee or br term "tertieNtidt• Ø opener under Cr-rc Cone 4 5 and has heed a matte ~haleis mentoon loth ~MA ih milda 4 4 nmsr~cdr plan. • cc:outs:My Mond benefit Pan . a gmsernmental pia,. an ~et we "are benefit pLirn, at a church pan caret' ceder the lambs'« Atelffifilfsl ~OM SIKW•tf Act of 197.11 The 1rtrettor reds :von elates einedon ~WI! is net 'greed so ~Ur/ with the CFTC (please "ndkate tne apgranle *remotion scar mown the Stiverta curs a råvar the haws upon witch the «netta hi s amentnera rat te911•41.nn fy an thortheas is ro: riCrait OR Entities that are NM hientes aritInt those ~nod to Mina with the Ute tnt "'WV *.01, a " pod. the operator Meted; regiments and wants 4 ' n testec n a ( ai'~ nut 4 Ramrod« at the SSA and n returel with tir Olt Mere ~Ste betm the rarity en wrath difelltfinX kr the operates theme s inclined (~y peo! oprratot. M/nrigSky r•ading Manor Mures eceromoon fl it. ~Odor"; tide, a teml foreign exhange dealer' With I tri any,asrcp Fr tit *Inch an ~et may~Way cØØ, ro Xenon 04 an aulatoyee) 4ontrtztOn n cohrnred as :reign retterssotes AldSlaracr.Ort 165 Pr ivale and Confidential CONFIDENTIAL UBSTERRAMAR00001537 EFTA00237182  Investor Application Form (continued) G. Certification Regarding Initial Public Equity Offenngs: *titif ' 3.. Rule 5130 'Restncted Persons' -- 'n Epos 'nay 0 161021 TO Invest in new 'rest e.*n of riar nclendual account is triple for such transactions Please Initial the appropriate owing* : he ;indenturedhas rebated toe statements • •;vvyttoek partopiskt, •!J.}, 7 , .:r." entry which btlob retch apcOy to it or. 4 the Undengned n a espy to are onion •sreng a Ilempfitial Meads' en the Und046Ine4 Ma Pamela is any of the Shone; — :a) Alfa menthe. Nth Or MP bider dealer thi An once, director. grunt parer, YOCK rad pOINCM of employee of frifiNRA member fen oc other Cowed Broker Owlet. _ c) An agent ol a Covered Pool& Dear if the agent is engaged et the soveorent Dart erg o *cages business _ 40 Au AnnetAate tar:Nosy Monte of a perm ladled m 33 a 4. about. _ hie) Milder a other person acing tendons,/ raparib to a Cowen Stoker Dote. fncluding atterarn. accountants and ruuncial conpliants, - (f` A persons nas the autaxxity to buy a see securities to. be*. sang+ and ban ettlautton. retuned compare. OWOAttill company. %segment %%Met or Collide inetsenent Newti flef nthOnfleth fir* %%oaf of e ;WSW toecittte n (e; or ih atom *he receives from a provubs to such person htateftei Subtssrl. A sedan bated for waned to be sue* 4+ Schedule A a SchedukCsa form SD ea <wenn; 10% Of mote of a Covered &carer Dot, - lit Amnon budlc. red eyed to be bat4 in Schedule ft or USW* C Of f 'Most ennifflf retie 4 Madden Med in 33 13 Amnon that Cram 3 4( .byoreentist 10% a room rie e public everting cow., treed lot requires to be Wed:len Schedule A of fans FE) with respect o a Coaled Woke Deatec, other ma, a fAbk (ceremony trot is idled on a nate:out %IMAMS tither 00 Amnon that owns &nib a indrecib 25% or mat of a peatat CIPOCAMO oflany that is a ptescr, hated u i., abate than a Mb% company that 6 filled on a Mikeflig SCCO/44401111011., Other Or AO lend ite tan, te Afeenbr a' a ceaSOn Wed N Peough % mole *no Went lion, or ceOesdeS to such Isbson Mang fuipput. Cm: An *masa 1Actxlent) a cotporaraa+. prtheffrect Weed CASA% cOffarl. Doff a n efthffiro/ 4414° a y of **Peon mine" to fff 0110,44 IO Ode has a Senekut inWeS1 tare pen to ie: fr ttliatch 'm) a "5130 Retheletl Penbn", ‘c . Milfr,a4"1O1 NY. Of OA. abbe For &MOM only If you Irtibalad airy of items (a) though Cm) above. you may ail be eligible to pertiapete in 'new issues' if you dusty one of the demptiona listed under • New Issues Faempuccut at the bed et the Subscription Agreement If so. pins* specify the exemption number Stough t0)111110 exerthabon 1(b) is not available} NOTE: EMOMPOOAS ate not Applicable toe individual retirement redound individual or Mutt accounts, UGAIA or !JIMA accounts. which an treated in natural persons foe this purpose. Pude and Coolider is: CONFIDENTIAL UBSTERRAMAR00001538 EFTA00237183