EFTA00089254.pdf

Trust Signature Page 5110 01MO1311ONV NOS Al trustees must sign this document. By siring below, I acknowledge that I understand and agree with the terms and conditions of the LISS Client Relationship Agreement the Agreements and Disclosures booklet and addendum, and if applicable, the Agreements and Disclosures for IRAs, and the Retirement Plan Disclosures available at wowassomtrettemeatglanetiscksiLes that b enclosed or that I have previously received. I agree that the representations In these documents are accurate and that I will be bound by the terms and conditions In these documents. Trustee Certification By signing below, I represent that ( have reviewed the Trust Agreement and any other documents governing the trust As uustee, I have full power under the Trust Agreement to make this Trust Certification and have consulted with my legal counsel. if necessary. Investment and other Powers and Restrictions We represent and warrant that, except as indicated below, we have broad investment and other powers under the trust agreement and applicable law to enter into transactions and to trade, buy, sell, sell short or otherwise acquire, receive, deliver, assign, endorse for transfer, hold or dispose of all manner of securities, futures, currencies and commodities (incluang options or warrants on securities, futures, currencies or commodities) Cr to purchase and surrender insurance policies and annuity contracts or interest in any of the foregoing in whatever form they may take, and whether by dna ownership or by interest in funds, partnerships, pods or other forms of colective ownership, except the types of investments specifically kited below LOAM and Other Credit Transactions We represent and warrant that we have broad powers under the trust agreement and applicable law to engage in borrowing and Other loan and credit transactions with or through UBS for Investment and non-investment purposes, including margin loans, other loans, pledges, mortgages, hyputlecations, repurchase and reverse repurchase transactions, letters of credit, credit facilities, and guarantees of the obligations of third parties to UBS On each case, with no !irritations as to amount). We have the authority to pledge, mortgage, assign or subject to a security interest or lien in favor of UBS any property of any sort of the trust as security for any liability of the trust or third parties each case, (in with no imitations as to amount). We have the authority to execute any and all relevant documents and bind the trust In respect of any agreements entered into pursuant to this paragraph, except the types of borrowing or other loan or credit transactions listed below If the trust has multiple trustees or officers, can one trustee or officer act independently? \ et Yes No If No, specify the number of signatures required: (specify number or • air) If trustees do not have authority to hire an investment advisor or other third party, check here The person identified below is authorized to act as a successor trustee in the event of the death, resignation or removal of ail of the current trustees: Name: Title: Address. Margin Agreement t agree that the Margin Agreement in the Client Relationship Agreement applies to a0 of my margin-eligible accounts opened now or in the future. This means that if I use margin privileges, UBS will heal the securities in the margined accounts as collateral against the amounts borrowed. I agree to keep sufficient positions in margined account to meet any margin calls UBS may issue. I aiso understand that securities in any margined account may be loaned to 1185 or other persons or entities as described in the Margin Agreement. I understand that the Margin Agreement is not applicable to retirement accounts or any other accounts that are not eligible for margin privileges at UBS (including IRAs, ERISA plans, Coverdell Education Savings Accounts, 403(bX7) Accounts, UGMAIUTMA, Estate or 529 Accounts). Electronic Delivery Consent As requested, I received my Agreements and Disclosures booklet and other account-related documents electronically at jrobertsenuttercorn which is the e-mail address of record for all ov nts. understand that the information is also available at www.ubs.comiaccountdisdosures or by request to my Financial Advisor at Page of 11 Continued on next page 21 EFTA00089254  For Trust Account: Y1 45170 8 Y1 45172 Y1 45171 rj Check here if you have been notifiedand the IRS that you La are subject to backup withhcrding, and therefore have crossed out paragraph 2 in the Certification below. Exempt Payee Code (if any) If your organization is tax exempt please enter the appropriate code (codes t through 13 in the W9 instructions) Exemption from FATCA reporting code (if any): W-9 Form Certification Under penalties of perjury,Icertify , that (1) the number shown en thh form is my correct taxpayer identification number The Client Relationship (or I am waiting for a number to be Issued to me), and 2)1 am not subject to backup withholding because: (a) I am Agreement contains a exempt from backup withholcEng, or @)1have not been notified by the Internal Revenue Service (1R5) that I am subject to pre dispute arbitration backupvelthholdIng as a result of a farm to report al Interest and dividends, or (c) the IRS has notified me that 1 am no clause located in the final section under the title longer subject to backup withholding, and (3) I am a U.S. (Werra other U.S. Person (defined in the instruaiorts), and (4) -Arbitration.' The FATCA code(s) entered on this form Of any) Incicaang that I am exempt from FATCA reporting is correct. Certification Instruction: You must cross out item (2) above if you have been nOtifled by the IRS that you are currently subject to backup withholding because you have faced to report all interest and dividends on your tax rennin The Internal Revenue service does not require your /anent to any provision of this document other than the certifications required to avoid backup withholding. x ICl/SIC< - Teri Pate • I • . , • - • • . • - • • • • • _ • • • .. - ..... . • +.^ • Adakelit:aitelt.CP 7 . _ • 155 Seaport Boulevard ATTN: Nutter McClennen & Ash LLP Boston. MA 02210-2698 Emailalddresstofsffecot*'-b:- mo11 iii1111 Page 2 of 2 22 EFTA00089255 50f1 O1.1.4)111138 ONV NDIS Montpelier Trust. For Trust Accounts: Y1 45170 Y1 45172 Y1 45171 are subject to backup withhold:lg. and therefore have crossed out paragraph 2 in the Certfication below. Exempt Payee Code (if any) If your organization is tax exempt please enter the appropriate code (codes 1 through 13 in the W9 instructions) Exemption from FATCA reporting code (if any): W-9 Form Certification Under penalties of perjury, I certify that (1) the number shown on this fain is my correct taxpayer identification number The Client Relationship (or tam waiting for a number to be issued to me), and 2) I am not subject to backup withholding because: (a) I are Agreement contains a exempt from backup withholding, or (b) I have not been notified by the internal Revenue Service (IRS) that I am subject to pre-dispute arbitration backup withholding as a result of a f&ure to report all interest and dividends, Or (C) the IRS has notified me that I am no clause located in the final section under the title longer subject to backup withholding, and (3) I am a U.S. citizen or other U.S. person (defined in the instructions), and (4) - Arbitration; The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct Certification Instruction: You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because you have faded to report all interim and dividends on your tax return. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. pate j71217,0i & Date- ,r Rate Address•of.ReCOrd 15S Seaport Boulevard ATTN: Nutter McClennen & Fish LLP Boston, MA 02210-2698 Erabibiumiasi:otitliotii; ui Page 2 of 2 I IW 22 EFTA00089256  SON 01NI11113/1 (INV ND IS Montpelier Trust For Trust Accounts: Y1 45170 vl 45172 Y1 45171 y u ave peen rotaed by the IRS that you are subject to backup withholding, and therefore have crossed out paragraph 2 in the Certification below. Exempt Payee Cede (if any) if your organktadon is tax exempt please enter the appropriate code (codes 1 through 13 In the NiSintructIons) Exemption from FATCA reporting code Of any)! W-9 Fenn Certification Under penalties of peOury. I certify that (1) the number SAN/n on this form is my correct taxpayer identification number The Client Relationship (or I am waiting fora number to be issued to me), and 2) 1 am not wbject to backupwithholding because: Agreement contains a (a)I am exempt from backup withholding, or (b) I have not been notified by the internal Rewire Service ORS) that I am subject to pre-dispute arbitration backup withholding as a result of a Wore to report all intereSt and dividends. or (c) the IRS has notified me that I am clause located in the final no longer subject to backup withholding, and (3) i am a U.S citizen or other U.S person (defined in the instructions). and section under the title (4) "Arbitration.' The FATCA code@ entered on this form Of any) incicabrig that I am exempt from FATCA reporting IS Correct. Certification Instruction: You must COSS out item (2) abore if you base been notified by the IRS that you are current)) , subject to backup withholding because you have failed to report all interest and dividends on your tax return. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Address.of Record 155 Seaport Boulevard ATM: Nutter McCennen & Fish uP Boston. MA 02210-2698 Emalladdress of-Record 11111ui11 iu Page 2 of 2 II 1 22 EFTA00089257