EFTA00236456.pdf

UBS Financial Services Inc. UBS Account Number TIN Authorized Agent/Dual Signor Addendum To add an additional check user on the Resource Management Account' (BMA') or Business Services Account Bse, complete the Authorized Agent for RMNBusiness Services Account BSA Check Writing and the Account Holder Certification sections. To remove an authorized agent, complete the Authorized Agent Removal and the Account Holder Certification sections. If the duaksignature option is selected on the Account Application, complete the Dual Signors for RMAA3usiness Services Account BSA Check Writing and the Account Holder Certification sections. The Account Holder must sign the Account Holder Certification section located on the next page. Authorized Agent for BMA/Business Services Account MA Check Writing Each additional check user (who is riot a minor) named below is appointed an agent to me, unaffected by my subsequent disability or incompetence, to effect checking transactions m my designated UBS Financial Services inc. account. As indicated below, the additional check user is authorized to act on my behalf to write checks for the payment or withdrawal of funds drawn on the designated UBS Financial Services Inc. account or payable to me and bearing the signature or signatures now or hereafter authorized by me without limit as to amount, without inquiry and without regard to its application UBS Financial Services Inc. will send all confirmations, notices, demands, statements and other communications regarding checking activity in the designated UBS Financial Services Inc. account to me. IRS Financial Services Inc owes no loop . . . obligations to additional check users and may, but is not required to, act on instructions or respond to communications from such additional • . . - users • • . • • Agent First Name last Name Date of Birth 59 • - Country of Citizenship USA ❑ Other (specify): PassportKedula: Address Line Address Line 2 United States of America City State/Province ZipiPostal Code Country Home Phone Additional fees may apply Please see New Account booklet for details. Sign Here only if adding an authorized agent DWI% I tesn e Agent First Name last Name Agent Signature Date Authorized Agent Removal for RMA/Business Services Account BSA Check Writing if you are removing an authorized agent, please print the name of the agent you are removing below. Specify Name only if removing an agent. Agent First Name last Name 0123905603i AC-RW (Rev. 12/14) 02014 UBS Financial Services Inc. All rights reserved. Member SIPC Page 1/2 CONFIDENTIAL UBSTERRAMAR00000762 EFTA00236456  UBS Authorized Agent/Dual Signor Addendum Dual Signors for RMA/Business Services Account BSA Check Writing Duel-Signature checks require two signatures at all times. if you are designating more than two signors and you would like one of the signors to be required, at all times, please check 'Required' next to the signoes name. Only one individual can be a required signor. If you do not designate a required signor, please specify all signors as optional. If the individual designated below is not a UBS Financial Services Inc client (i e. account holder, authorized agent, power of attorney, etc ) also complete the Authorized Agent for RMABusiness Services Account BSA Check Writing section above. E Check here if you do NOT want UBS Financial Services Inc to order new dual signature checks If checked, you will be responsible for obtaining checks with dual signatures. 1185 Financial Services Inc will not accept single signature checks. Dual Signor First Name Last Name Dual Signor First Name Last Name Specify the type of signor. 0 Required 0 Optional Specify the type of signor: ❑ Required Optional Sign Here only if adding a Dual Signor Dual Signet's Signature Date Dual Signor's Signature Date Note: you must complete and sign a new addendum to add, remove or update dual signors. U8S Financial Services Inc wil rely on the most recently dated addendum to supercede and replace any other previous dual signor addendum on file Account Holder Certification By signing below, I UNDERSTAND, ACKNOWLEDGE AM) AGREE that (1)1have reviewed all of the information contained in this addendum and I declare it as true and accurate and t2) UBS Financial Services Inc is authorized to rely upon the authority conferred by this document until UBS Financial Services Inc. receives an updated copy of this form revoking or modifying this addendum (nhicirnne )( Account Holder First Name Account Holder Signature Date Account Holder Fest Name Last Name Account Holder Signature Date 0123905603i AC RW iRev 12/14) O2014 UBS Financial Services Inc All ghts reserved. Member SIPC Page 2i. CONFIDENTIAL UBSTERRAMAR00000763 EFTA00236457