📄 Extracted Text (1,124 words)
UBS Financial Services Inc.
UBS Account Number N(123576
Electronic Funds Transfer Service
Permissions for Non-UBS Financial Services Inc, Accounts ("External Accounts")
Complete the information below to make transfers to or from your accounts at financial institutions other than UBS Financial Services Inc.
To authorize 1.185 to initiate withdrawals from an external account, please complete the information below and attach a voided check
(for checking accounts) or a deposit slip (for savings account). If neither is available a dient statement or letter on bank stationery
confirming account title, account number, and ABA routing number is sufficient.
NOTE: To initiate withdrawals from an external account that you have authority over, but is titled differently, a signed Letter of Authorization
from all other account holders is required.
External Account Information
Capital One
Name of Financial Institution
ABA Routing Number Account Number
Account Type: 0 Savings El Checking
Financial Institution Telephone Number For a money market account, select "Checking' account type.
Brian Yurasits
Account Title/Name
External Account Permission: (select all that apply)
Select all types of transactions that you authorize U8S to initiate upon instructions from authorized persons.
Instructions may be given through a UBS representative, U8S Resource Line. UBS Online Services or this form subject to verification ($100,000
maxinum via ResourceUne. 51,000,000 maximum via UK Online Services)
El Deposit to External Account 0 Withdraw from External Account (including Withdrawals to Pay UBS Credit Card)
Permissions for other UBS Financial Services Inc. Accounts ("Internal Accounts")
Complete the "information below to make transfers to or from other UBS Financial Services inc. accounts.
UBS Financial Services Inc. Account Number
Account TitletName
Internal Account Permission: (select all that apply)
0 Deposit to authorized internal account 0 Withdraw from authorized internal account
Allow UBS to Initiate "On Demand' Transfers to or from Accounts upon Verbal Authorization:
By signing below, you authorize UBS Financial Services to accept verbal authorization from any person with authority over this Account to
initiate 'On Demand' transfers to or from any account listed above up to S (max. amount $100,000 if left blank).
This authorization will remain in effect until cancelled by a person with authority over this Account. You must also select one of the Account
Permissions above.
O Decline on Demand Transfers. Check the box at left if you do not wish to allow verbal authorization for UBS to initiate transfers to or
from accounts listed above.
Branch Initiated Transfers require the client's verbal consent for the branch to initiate the transfer and are limited to the External Account
Permission selected for that account.
Fill out the below for zerappg transfer/payment instructions
Payment Type Starting Process End Date Frequency Amount Bank or RMA Account
Date Number
Account Title
0216247736 i
AC-FT (Rev. 03/17) 020t7 UBS Financial Services Inc. All ights reserved. Member SIPC. Page 1 4
CONFIDENTIAL UBSTERRAMAR00003277
EFTA00238652
UBS
Payment Type Starting Process End Date Frequency Amount Bank or RMA Account
Date Number
Account Title
Fill out the below for mkt= transfer/payment instructions
Payment Type Starting Process Amount Bank or RMA Account
Date Number
Account Title
Payment Type Starting Process Amount Bank or RMA Account
Date Number
Account Title
Payment Type—Indicate whether transfer is a withdrawal "W' from your External or Internal account or 'D" deposit to your External account
P" for withdrawals to pay your UBScredit card. Payment type must be indicated for each transaction.
Starting Process Date—Enter the Process Date that the Deposit/WithdrawaVCredit Card Payment should be initiated. For recurring
withdrawals to pay your UBS credit card, valid Process Dates are between the ICin and 20°' of the month.
End Date—Enter an end date for the Foal Deposit/WithdrawaVPayment. The final transactions will process on this date.
Frequency for recurring payment only—Enter one of the following: Weekly, Bi-weekly, Monthly, Quarterly, Semiannually or Annually. For
withdrawals to pay your UBS credit card enter Monthly.
Amount—Enter amount you wish to have deposRedAvithdrawn for each instruction listed. For withdrawals to pay your UBS credit card enter
Statement Balance, Minimum Due or a fixed dollar amount."
Bank or RMA Account Number—Indicate the bank/credit union account rarnber from which you wish to make deposits/withdrawals or the
RMA account number you wish to make deposits to or withdrawals from.
Bank Name or RMA Account Title—Indicate name of bank/credit union or the RMA account you wish to make deposits to or withdrawals
from.
*NOTE: For withdrawals to pay your UBS credit card: If your Minimum Payment Due for any month is greater than the Fixed Payment Amount
you selected, you authorize us to deduct that Minimum Payment Due instead. If your Statement Balance for any month is less than the Fixed
Payment Amount you selected, you authorize us to deduct that Statement Balance instead.
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0216247736'
AC-FT (Rev. 03/17) O2017 UBS Financial Services lac. All rghts eserved 'Ac-rnr,er
CONFIDENTIAL UBSTERFtAMAR00003278
EFTA00238653
*1UBS
Client Authorization
I authorize UBS Financial Services Inc. and its processing institution (the 'Processing Bank') to initiate the types of transactions indicated above
(including adjustments for any entries made in error) to or from my account(s) listed above, and authorize the depository(ies) named on my
authorized External Account(s) or UBS Financial Service Inc. to debit and/or credit the requested transactions to my accounts. I authorize UBS
Financial Services Inc. and the Processing Bank to make changes and/or cancellations to transactions requested by me. 1 further acknowledge
that electronic funds transfers under this authorization may be processed as automated clearing house (ACH) debit and credit entries.
understand when I authorize a withdrawal from an authorized external account to pay my UBS credit card, UBS Financial Services will initiate
art electronic funds transfer from my authorized external account and make a bill payment to UBS Bank USA.
I understand these instructions will remain in effect until UBS Financial Services, Inc. has received written notification front me of termination or
modification in such time and mariner as to afford UBS Financial Services, Inc. a reasonable opportunity to act on it. If I close or change any
account listed above. I will promptly notify UBS Financial Services Inc. of this change.
I authorize OBS Financial Services Inc. at its discretion to discontinue the electronic funds transfer and bill payment service from any accounts
listed above if I fail to maintain adequate funds in such account(s) to cover my requested transfers or payments. All electronic funds transfers will
be initiated in accordance with this authorization and the terms and conditions governing my Account. I acknowledge that the initiation of
electronic funds transfers must comply with applicable U.S. law.
Ghislaine Maxwell X X
Account Holder First Name Last Name Account Holder Signature Date
0 Account Holder First Name Last Name Account Holder Signature Date
0216247736 1
AC-FT (Rev. 03/17) 02017 OBS Financial Services rt< All c gMs eserved. Member SIP( e.
CONFIDENTIAL UBSTERRAMAR00003279
EFTA00238654
ℹ️ Document Details
SHA-256
972224832284d4e1242bd7403ba669a7341d95e738b1356b4006a00c119d3e1f
Bates Number
EFTA00238652
Dataset
DataSet-9
Document Type
document
Pages
3
Comments 0