EFTA00236458.pdf

SUBS UBS Financial Services Inc. Account Number PWM Office Private Wealth Advisor Power of Attorney (PWM) (Not for use when naming a professional Investment Advisor) • • Account Name ' ' Initial here to have this authorization apply to all accounts at UBS Financial Services Inc in the same name, whether currently open or opened in *' the future .•. ' • ' • • • This will confirm the authority of .•. •. 7)on ie 1 V-eSo et (Agent Name) to perform each of the actions initialed below and to take any and at actions necessary for or incidental to carrying out such authorizations including the execution of documents or forms or other authorizations , • • • Note. When used in this document, the words or 'me' or 'my' refer to each of the dients)/principaks), individual(s) or entit(ies), that executes this Power of Attorney. ach client must initial in the box next to each agency granted. FtEASE SEE IMPORTANT DISCLOSURES REGARDING TRADING • AUTHORIZATION FOR UBS PACE AND STRATEGIC ADVISOR ACCOUNTS ON PAGES 2 . • AND 3. •• . • ••, • • • . • . • Trading Authorization I initial here to authorize my Agent to enter orders with you to purchase and sell securities and similar property (including options transactions), in accordance with the qualifications, eligibility and general terms and conditions for my account(s). as brokers or dealers acting for my own account(s), or as brokers for some other person. Managed Account Authorization I initial here to authorize my Agent to ervoll my account in any investment advisory program offered by UBS. to execute the Investment Advisory Relationship Agreement or applicable forms, and specifically to hire and terminate discretionary and non• discretionary investment managers. I understand that the Advisory Relationship Agreement, whether executed by me or my Agent. will apply to all UBS advisory program accounts that I may open in the future Disbursement Authorizations I initial here to authorize my Agent to instruct t)8S to transfer money or securities to accounts held in my name or for my benefit, and to make tax withholding elections on my behalf in connection with any transfer authorized under this Power of Attorney. Such transfers may be effected by methods which include but are not limited to journal entries, wire transfer, electronic funds transfer or checks Tax Documents Authorization initial here to authorize my Agent to make. execute and present tax forms, including without limitation all US Internal Revenue Service Forms W'8 and W-9. as applicable, and any related documents Duplicate Account Information Authorization I initial here to authorize my Agent to receive a duplicate copy of all confirmations, statements and other communications Multiple Agents It I have designated multiple agents to act on my account(s). I direct that each agent is authorized to act Independently of any other agent. If UBS Financial Services Inc. determines, in its sole discretion, that it is receiving conflicting instructions from agents that I have designated, I authorize UBS Financial Services Inc_ in its discretion to stop taking instructions from any of my agents until the conflict is resolved either at my direction or by my desiguted agents. ign this section if you intend that multiple agents must act jointly. unless signed below, you authorize each agent to act separately. If t have designated more than one agent for my accounts. I direct that UBS Financial Services Inc act only upon the joint instructions of all designated agents Il Client First Name Last Name Signature Date AC-MZ (Rev. 12/14) 02014 UBS Financial Services Inc All rights reserved. Member SIPC. hilt- 1/3 CONFIDENTIAL UBSTERRAMAR00000764 EFTA00236458  UBS Agreement By signing below. I agree to indemnify and hold harmless U85 and its affiliates and all of thew employees and agents from and against any and all claims that may arise by reason of UBS having relied on the provisions of this instrument 1 acknowledge and agree that my agent is authorized to make any trade for which my account is eligible of approved. including margin trades and shat sales and to receive any and al account information I hereby ratify, confirm and agree to be bound by any and all transactions, trades or dealings, whether written or verbal, effected in and for my account(s) by my agent in connection with the authority granted in this instrument, including, but not limited to. the execution of documents, forms or agreements or any authorizations. If I have instructed that this Power of Attorney be accepted in a Trust or Business Service Account, I expressly acknowledge and agree that, by signing below, I delegate the foregoing authority I have as Trustee or Officer. Member, Manager, Partner or other representative duly authorized, and sign this Power of Attorney in such representative capacity or capacities as applicable for the accounts to which this authorization applies This Power of Attorney will be subject to, controlled by and interpreted in accordance with the laws of the State of New York, without giving effect to any principles of choice of law or conflict of laws (notwithstanding any provision to the contrary contained in any application for any account at U8S or in any other document) UBS is entitled to rely on this Power of Attorney until wntten notice of as revocation is delivered to the branch office where the account is maintained and receipt is acknowledged by UBS Enrollment in discretionary UBS Investment Advisory programs will, for those accounts, immediately and effectively revoke any trading authorization granted herein. In addition, some of the services you have selected may be subject to limitations on their availability as requited by law, regulation, rule or our policies. and under those circumstances, these services may be terminated or declined in UBS' sole discretion For example, UBS Financial Advisors cannot be appointed Power of Attorney in any retirement account. This is an important legal document. Before executing this document, you should know these important facts: • This document may provide the person you designate as your agent/attorney-in-fact with broad powers, including power to manage, sell, dispose of the assets in your account or borrow money using your property as security for the loan. • If you are using this Power of Attorney in a Retirement Account, you should be aware that the agent is not authorized under this document to make or change beneficiary designations on your account. If Power of Attorney is granted on behalf of an entity (e.g. trust), please provide the client name(s) and your name as representative of that client (e g . *as trustee') 'IMPORTANT NOTICE FOR PACE/STRATEGIC ADVISOR ACCOUNTS: Ongoing advice from the U85 Financial Advisor is a principal component of the services clients pay for in these programs. As such, clients may not designate a Power of Attorney for the purpose of :obtaining investment advice on a UBS PACE/Strategic Advisor account This includes registered or unregistered investment advisors, .' consultants, financial planners or similar parties C-IVitstakne 1-Aci,V34/ e Client First Name Last Name Signature Date * Client Fist Name Last Name Signature Date In the presence of (cannot be the Agent) Witness First Name Last Name Signature Date Client must sign and date in the presence of a witness who must also sign and date this form. (IMPORTANT NOTICE FOR PACE/STRATEGIC ADVISOR ACCOUNTS: Ongoing advice from the UBS Financial Advisor is a principal component of the services clients pay for in these programs. As such clients may not designate a Power of Attorney for the purpose of obtaining investment advice on a UBS PACE/Strategic Advisor account. This includes registered or unregistered investment advisors, onsultants, financial planners or similar parties. By signing below. I confirm that I am not providing investment advice or consulting services to ,the client granting me agency on this account Don ei K-eSnei Agent First Name Last Name Signature Date AC-MZ (Rev. 12/14) O2014 UBS Financial Services Inc All ghts reserved. Member SIPC Page 213 CONFIDENTIAL UBSTERRAMAR00000765 EFTA00236459  UBS ADDITIONAL INFORMATION (To Be Completed by Agent) Basic Information El Check here if agent is UBS Financial Advisor or a registered associated person at UBS D0M e -.ESnef Agent First Name Middle Name Last Name Country of Citizenship x7int USA O Other (specify) Passport/Cedula: SSN >ft) If Address Line 1 Address Line 2 United States of America City State/Province Zip/Postal Code Country Home phone Agent's Relationship, if Any, to Principal Agent's Account No. With U85 (If Any) Financial Information nvestment Experience: How many yens have you held investment accounts? years Which best describes your knowledge of investments? O I know very little about financial markets and market investments. EI have a good understanding of financial markets and market investments. C I am an experienced investor in financial markets and market investments. Personal Information Date of Birth. Is the Agent affiliated with any securities firm, excluding UBS and its affiliates, broker/dealer subsidiary of a financial institution, securities or commodities exchange, self-iegulatory organization or the UBS aucator (currently Ernst & Young)? (NYSE Rule 407) O No O Yes (If blank, Firm assumes No). If yes, specify affiliated firm/organization. If you answer 'yes- to the NYSE Rule 407 question, approval must be obtained horn the specified funVorganization before the account can be opened a trading authority becomes effective Is the Agent an employee or related to an employee of UBS AG, its subsidiaries or affiliates (e g., UBS Financial Services Inc., UBS Securities (IC)? O No O Yes • specify AffiliaterSubsithaa Employee First Name Last Name SSN Employment Information Occupation. Employer Name and Address are only required if your employment status is 'employed' or 'self-employed' Status (select one)' O Employed El Sell-Employed [3 Student O Relined O Self-Supported E Volunteer O Unemployed fl Work in the Home Occupation Busness Phone (optional) Business Fax (optional) Employer Name Industry (re., Construction, Service, etc) (optional) Address line 1 Address Line 2 City State/Province Zip/Postal Code Count,. AC-MZ (Rev. 12/14) NIVIRMNI 02014 UBS Financial Services Inc AU tights nerved. Member 51K :age 3 CONFIDENTIAL UBSTERRAMAR00000766 EFTA00236460