EFTA01273285.pdf

SUBS UBS Financial Services Inc. Account Nurnoer Cicnt Fund Investment Application Cover Sheet ALPHAKEYS MILLENNIUM FUND LLC Fund Name Ghblaine Maxwell Account title Ghklalne Maxwell Client Name ACU6 Form ML2,31837 Control Number 102725 Appkation Id ECS-0155002191 III FCS-0155002191 For Internal UseOnly CI 2007 UBS Financial Services Inc. AN Rights Reserved. Member SPC CONFIDENTIAL SDNY_GM_00020458 EFTA_00131078 EFTA01273285  UBS AlphaKeys Millennium Fund, L.L.C. Investor Application Form Investor(s) Please: • Complete the Investor Application Form via UBS Online Services ('OLS") Q8 return this entire Subscription Booklet to your Financial Advisor. • Only fully completed Subscription Booklets (no faxes, no copies) will be accepted. • DO NOT TEAR OUT PAGES. • Retain a copy for your files. • Read the Fund's Memorandum and the Subscription Agreement. • Please refer to the enclosed Tax Forms and speak to your UBS Financial Advisor. You may not be required to complete these forms if your UBS account has already been designated FATCA- compliant. Be sure to complete all sections of the Investor Application Form Financial Advisors/Branch Managers • Effective July 1, 2014, FATCA compliant tax forms are required for clients to execute new investments in all Alternative Investments. Please refer to the enclosed Tax Forms and related submission instructions. • Please refer to the Fund Investment Application (' FIA") QuickCard for application submission instructions, or call UBS Altemative Investments US at 888-962-3842, option 1, sub option 4. • All Investor Applications must be submitted on FIA to UBS Alternative Investments US no later than 4 full business days prior to month's end. ML281817-MAXWELL Private and Confidential SDNY_GM_00020459 CONFIDENTIAL EFTA_00131079 EFTA01273286 Instructions for Completing Investor Application Prospective investors in the AlphaKeys Millennium Fund, L.LC. (the 'Fund") should read the Memorandum as well as this Subscription Booklet prior to subscribing. Please complete all sections of the Investor Application Form. If you invest via O1.5 please follow the instructions on the OLS system and/or the enclosed informational card. If you invest via this Subscription Booklet please promptly retum the entire Subscription Booklet to your Financial Advisor. Do not tear out any pages. Retain a copy for your files. Please refer to Schedule 2 for the meanings of the capitalized terms used herein. Please consult your Financial Advisor or call UBS Alternative Investments US for assistance in completing this Investor Application Form. A. Capital Contribution Amount • Indicate the Capital Contribution applied for (which may be accepted in whole or in part by UBSFA). • Provide your Account Number. • Funds must be drawn on an account that corresponds exactly to the name of Undersigned. UBSFA may in its sole and absolute discretion accept as your Capital Contribution an amount less than the Capital Contribution applied for herein. CLEARED FUNDS MUST BE IN YOUR ACCOUNT 5 BUSINESS DAYS PRIOR TO MONTH'S END. B. Investor Information: • Provide the Investor's mailing address exactly as it should appear on the address labels. • Include the Investor's state of residence or principal place of business, if applicable, and Social Security/Tax ID Number. • Provide the Investors email address. C. Accredited Investor Representation: Please read Schedule 1 and check the appropriate box. Generally, an "accredited investor' has a net worth in excess of $1 million for individuals (together with spouse) or total assets in excess of $S million for entities. To calculate net worth, exdude the value of your primary residence, and count as a liability any indebtedness secured by that property in excecc of the fair market value of that property. If you incurred the debt on your property within 60 days of subscribing for this investment and did not use those funds to purchase that house, you must include the full value of the debt as part of your liabilities. The Investor must certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund, unless otherwise determined by UBSFA. ML281817-MAXWELL Private and Confidential 2 SDNY_GM_00020460 CONFIDENTIAL EFTA_00131080 EFTA01273287 Instructions for Completing Investor Application (continued) D. Qualified Purchaser Representation: Please read Schedule 1 and check the appropriate boxes. Generally, a 'qualified purchaser must be an individual or beneficiary of an IRA- or participant-directed plan or family trust/entity with at least S5 million in qualified investments or an entity with at least S25 million in qualified investments. The Undersigned must certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund. E. Benefit Plan Investor Status: Please read carefully and check the appropriate box. F. Controlling Person Status: Please read carefully and check the appropriate box. G. Certification Regarding Initial Public Equity Offerings: Please initial and complete all applicable sections. H. Government Entity Status: Please read carefully and check the appropriate box(es). I. NFA Bylaw 1101 certification Please read carefully and initial the applicable acknowledgement(s). .1. Investor Acknowledgement: Please read the acknowledgements contained in this section carefully, initial the applicable acknowledgements and complete the applicable certification(s). K. Investor Signatures: Please sign. ML281817-MAXWELL Private and Confidential 3 SDNY_GM_00020461 CONFIDENTIAL EFTA_00I 31081 EFTA01273288 Schedule 1 PLEASE REFER TO THE REPRESENTATIONS BELOW IN ORDER TO COMPLETE THE INVESTOR TYPE, ACCREDITED INVESTOR AND QUALIFIED PURCHASER REPRESENTATION QUESTIONS OF THE INVESTOR APPUCATION FORM. ACCREDITED INVESTOR STATUS AND N. Corporations, Partnerships, Limited QUAURED PURCHASER STATUS QUALIFIED PURCHASER STATUS Liability Companies and Other Entities V. Individuals, Joint Tenants and IRAs The Undersigned must certify that he, she or {a) The Undersigned is a corporation, (as applicable) it is an accredited investor and a qualified partnersheo, United liability company, purchaser based on the categories listed Massachusetts or similar business trust, a The Undersigned is a qualified purchaser below. an organization described in Section because he/she (alone, or together with 501(cX3) of the Internal Revenue Code of his/her spouse, if investing jointly) owns not ACCREDITED INVESTOR STATUS 1986, as amended (the "Code"), not less than SS million in investments.• • I. Individuals, Joint Tenants and IRAs formed for the specific purpose of investing VI. 'Family" Corporations, "Family in the Fund, with total assets in excess of $5 Foundations, •Family Endowment, The Undersigned, either individually or million; or "Family Partnerships, "Family Trusts or together with the Undersigned's spouse, has other "Family" Entities a net worth* in excess of 11 million. N) Each shareholder, partner, or other equity owner of the Undersigned, as the (a) The Undersigned was not formed for II. Trusts case night be, is an accredited investor; or the specific purpose of investing in the (a) The trust has (i) total assets in excess of (0 The Undersigned is a 'bank' as Fund; S5 million, (ii) it was not formed for the delned in Section 3(3X2) of the Securities specific purpose of investng in the Fund, (b) The Undersigned owns not less than S5 Act or a 'savings and loan association' a million in investments;• • and and (ii) its investment in the Fund is directed other institution referred to in Section by a person who has such knowledge and 3(aX5XA) of the Securities Act, whether (c) The Undersigned is owned directly or experience in financial and business matters acting in its individual or fiduciary capacity; indirectly by or for (i) two or more natural that he or she is capable of evaluating the or persons who are (A) related as siblings or merits and risks of an investment in the spouses (including former spouses), or (B) Fund; or (d) The Undersigned is a 'broker a direct lineal descendants by birth or dealer' registered pursuant to Section 15 of adoption. (ii) spouses of such persons, (b) Each Grantor of the trust has the the Securities Exchange Act; or (ii) the estates of such persons or power to revoke the trust and regain title to (iv) foundations, charitable organizations or the trust assets, and each grantor is an (e) The Undersigned is an 'insurance company' as defined in Section 2(aX13) of trusts established by or for the benefit of accredited investor; a such persons. the Securities Act; or (c) The trustee of the trust is a 'bank' as VR Trusts (Other than Trusts that defined in Section 3(aX2) of the Securities (t) The Undersigned is an "investrrent company' registered under the Investment qualify under VI or VIII hereof) Act or a savings and loan association or other institution referred to in Section Company Act; or (a) The Undersigned was not formed for 3(aXS)(A) of the Sectxities Act (g) The Undersigned is a 'small business the specific purpose of investing in the investment company' licensed by the U.S. Fund; and III. Retirement Flans Small Business Administration under Section (b) The trustee or other authorized person (a) The plan has total assets in excess of S5 (301X0 or (d) of the Small Business making decisions with respect to the trust, Milian; or Investment Act; or and each Settlor or other person who has (b) Each participant n the plan is an (h) The Undersigned is a • business contributed asset to the trust, is a person accredited investor; or development company' as defined in described in V, VI, Val or IX. Section 2(aX48) of the ►'vestment Company VIII. Other Entities (c) The plan is partiopant directed, with Act or a 'business development company' investment decisions made solely by persons defined in Section 202(aX22) of the (a) The Undersigned was not formed for who are accredited investors; or Investment Advisers Act. the specific purpose of investing in the (d) Investment decisiorts for the plan are Fund; and Note for Accredited Investor Status: made by a 'plan fiduciary' as defined in • The term net worth means total assets Section 3(21) of ERISA that s a bank, (b) The Undersigned is an entity, acting for at fair market vNue minus total liabilities. its own account or for the accounts of other insurance company, registered inverment To c.slailate net worth: () exclude the fair qualified purchasers, which in the aggregate adviser or savings and loan association market value of your primary residence; (ii) owns and invests on a discretionary base, count as a liability any indebtedness secured not less than S25 million in investments.• • by that property josxcsss of the fair market value of that property. except that if you incurred that debt on your property within 60 days of subscribing for this investment and did not use those funds to purchase that house, you must include the full value of the debt as part of your liabilities. ML281817-MAXWELL Private and Confidential 4 SDNY_GM_00020462 CONFIDENTIAL EFTA (X)131082 EFTA01273289 Schedule 1 (continued) QUALIFIED PURCHASER STATUS (can't!) a Investors that checked X(b) or X(c) Control Securities may be included in must also respond YES or NO to XII 'investments' if (A) the issuer of the IX. Entitles that do not qualify under Control Securities is itself a registered or VI-VIII Is any direct or indrect beneficial owner of private investment company or is exempted the Undersigned itself a Section 3(cX1) a from the definition of investment company The Undersigned is a qualified purchaser 3(cX7) Company that controls, is controlled by Rule 3a-6 or Rule 3a-7 under the because each beneficial owner of the by, a is under common control with the Investment Company Act, (8) the Control Investor's securities is a qualified purchaser Undersigned? If the Undersigned cannot Securities represent securities of an issuer as descnbed herein. answer NO to XII because it has a control that files reports pursuant to Section 13 or relationship with a beneficial owner that is 15(d) of the Securities Exchange Act, (C) the Note: itself a Section 3(c)(1) or 3(cX7) Company, issuer of the Control Securities has a dass of Trusts may not rely on this certification even the Undersigned may be required to obtain securities listed on a designated off-shore if all of their beneficiaries are qualified consent from the security holders of such securities market under Regulation S under purchasers. owner. the Securities Act or (0) the issuer of the Control Securities is a private company with X. MI Investors that are Entities Notes for Qualified Purchaser Status: shareholders' eouity not less than S50 •• The term 'investments' means any a millon determined in accordance with (a) The Undersigned is not a 3(c)(1) or 3(cX7) Company; or all (I) securities (as defined n the Securities generally accepted accounting principles, as Act), except for Control Securities unless reflected in the company's most recent (b) The Undersigned is a Section 3(c)(1) or otherwise included as described below; financial statements (provided such financial 3(0(7) Company but does not have ANY (2) futures contracts or options thereon held statements were issued within 16 months of Pre-April 30 Holders; or for investment purposes; (3) 005411 the date of Undersigned's purchase of commodities held for investment purposes; Interests). (c) the Undersigned is a Section 3(cX1) or (4) Swaps and other similar financial NOTE. in determining whether the S5 3(cX7) Company and has obtained consent contracts entered into for investment million or S2S million thresholds are met, to its treatment as a qualified purchaser purpose; (5) real estate held for irrvestment investment can be valued at cost or fair from all of its ere-April 30 Holders. purposes; and (6) cash and cash equivalents market value as of a recent date. If XL Investors that checked VI or VII may held for investment purposes. investments have been acquired with check XI Instead of X indebtedness, the amount of the indebtedness must be deducted in The Undersigned has obtained consent to its determining whether the threshold has been treatment as a Quaid-led purchaser from all met. of its trustees, drectOrs or general partners. ML281817-MAXWELL Private and Confidential 5 SDNY_GM_00020463 CONFIDENTIAL EFTA_00131083 EFTA01273290 Investor Application Form A. Capital Contribution Applied for: S 2c 00,0 Mote: Your account will be debited for your Capital Contribution plus the Placement Fee of 2% (which may be waived in limited circumstances). A Placement Fin will be in addition to your Capital Contribution. Please see the investor Acknowledgement section for additional information regarding the Placement Fee. Subscriptions will only be accepted in U.S. Dollars. Account (Cures cur may iresileble ) B. Investor Information: SSN/I r..x State. pri (1,40:. Widow./ PTigipat Fixed Phone: &sinew) Fax: Mr. Mrs. Ms. MM. Dr. Other Investor Address: Attention (Name:) E-mail; C. Accredited Investor Representation Check only one box. By executing this Investor Application, the Undersigned cerffies that he, she, a it (as applicable) has read and understands the instructions to this Investor Application inducing, but not limited to. the instrations to calculate the net worth for accredited Investors; and (i) if a "accredited irWeSta* under Regulation D (generally, net worth in excess of St nation for individuals (together with spouse) or total assets in excess of S5 million for entities) and has calafated net worth as moiled by the iratructions in this Investor Application. Please read Schedule 1 and check one appropriate box below. Note that you must be both an accredited investor and a qualified purchaser in order to invest in the Fund. If investor is an IndwidualARABoint Tenant (with Rights of Survivorship). check here: ) If investor is a Revocable Trust, check has. O (Ilia or O (gb or O (gc Invests is an irrevocable Trust, O 00a a check here: O (r< If Investor is a Participant-Directed Retirement Ran, check here: O OM it Investor is Other Retirement Plan, CI gibe or O (labor O (lad check here: If Investor is a Corporation, Partnership, Limited Liability Company and Other Entity, ❑ (Mao O (Mb or O (Alcor O Ond cr O (tile or O PO or O 01.09 or CI (N)h check here: ML281817-MAXWELL Private and Confidential 6 SDNY_GM_00020464 CONFIDENTIAL EFTA_00131084 EFTA01273291 Investor Application Form (continued) D. Qualified Purchaser Representation: The Undersigned is a 'qualified purchaser' under the trnestrnent Company Act (generally, individuate, beneficiaries of Etaniparticipant-drerted piers, and familyttnst entities must own at least $5 million or more in qualified investments and entities must own and invest at least $25 mdion in qualified investments). The Undersigned must certify that he, she or rt is both an accreted investor and a quailed purchaser in order to invest in the Fund. Please read Schedule 1 and check the appropriate boxes. Trust entitles should read carefully the specific squalled purchaser requirements on Schedule 1, including the requirement (for trusts other than MIS relying on certifications in VI and Vim that both the trustee (or other authorized person making decisions with respect to the bust) and each Senor or other person who has contributed assets to the trust must own at least 55 million in qualfreci investments. The Undersigned's execution of this Investor Application constitutes certification of the Undersigned's status as a 'qualified purchaser. • If Investor is an Individual or IRA- or Participant-Directed Retirement Flan, check here: elm If Investor is a ▪ amity' Corporation. • Fantle Foundation, • randy" Endowment, O Ma, band c AND 0 Macs 0 Mt' or 0 (10c* or 0 DM ' Family- Partnerships. • Famly- Tests or Other ' Family' Entitles, check here: If investor is a Trust (other than a Trust that qualifies under M or O MN and b MID CI 00a or 0 NV or 0 OOO1* 0 NO VIII), check here: If :nests is another type of O 0/114 and b MID O Oa or 0 pOb• or 0 (X)c• or 0 DO Entity, check here. If Investor is an Entity that does not qualify under WW1 check O 0>0 MID CI Oge or 0 Mb* or 0 ()c• or 0 CYO here: investors that checked X(b) an you choded Mb or la above. X(c) must also respond CHICK YES OR NO BELOW YES or NO to tern XII 0 YES or 0 NO E. Benefit Plan Investor Status: Please certify, by checking the appropriate box below, \tether the Investor is or will be described in any of the following categories: (1) an 'employee benefit plan' (as defined in Section 3(3) of ERISA) that is subject to (NSA; (2) a "plan' (as defined in Section 4975(01) of the Code) that is subaect to Section 4975 of the Code; or (3) an entity which is deemed to be a 'benefit plan investor" or to hold "plan assets' under the Plan Assets Rules by reason of scatty investments in such entity by one or more persons described in clause (1) or (2) abase. Examples of the foregoing include, among other things. 'Keogh' plans, other tax-quaified retirement plans, IRAs, certath other types of employee benefit plans (and accounts) and entities that are deem* i ii to hold "plan assets' thereof. Check one 0 YES or NO F. Controlling Person Status: ',ease certify, by checking the appropriate box below, *tether the Investor is or will be described in any of the following categories: (0 a person oe entity that has discretnary authority or control with respect to the assets of the Fund; (N a person or entity that provides investment advice for a tee trect or incrirett) with respect to the assets of the Fund; or (IN an 'affiliate' of a person or entity described in cause (Dort above. For purposes of this representation, an 'affiliate of a person or entity includes any person or entity controling, controlled by or under common control with the person or entity, inducing by reason of having the power to exercise a controing Influence over the management or policies of the persona entity. Check one: 0 YES or /NO ML281817 -MAXWELL Private and Confidential 7 SONY_GM_00020465 CONFIDENTIAL EFTA_00131085 EFTA01273292  Investor Application Form (continued) G. Certification Regarding India/ Public Equety OH«IngS: i s b ("L . Ruh S130 'Restricted ~ tr ' . o..'r<iurge ins, etc ogi e: erkke: in %h. ~ M44 d lac Tørdsabli =apt: 4 419~ lie well Iferisactom . • nee« ISOM the appeepelet• Staallii :nt ..;.44•4044.4..4• , taet. (toe. WIWP44.44 Wks* 4....., ersfrep :0 fr et a `44...ficeisreci .5 • . . : . tiporyben esertn•iffr 'rs.fit V arr 44,4:1, sir.:,• eØ t.^. fry X4O:r '..4.ni• tanefeclal leered r. es icideetrea Rev ensue es bay el itee tealeary _ a. .4 , 4•:•.: ^4.41fre !--,' Iv Gfrfr ne free Ma' .,_ b .fr" 49 .fr. 4?•t!Zr Q4.49.4 frarfrr 4%.4.4:44 I.414.` A) .1444:444 . 1 • , ',11.4 .1.4f404. WS O. 01?* 4.0A4Ard &free ..."eake :...ders si • ern. a ii mt: C.1411 4 ri• awn: 5 eiNeiCeci - Me millImeer cianfil 0 it... - rbeAteen C Zn .,443./if , r04.1" , -t. 0, •00.0” a- bound, c• A 40fra . ^ . 140 i" Mcm PI' 0 ' m589 e s 8---edif :4041. N al • •-.2.4r44 &talk (»Pe'. hhask: Nereid. N.00•• 81.18N Sic • '..ixia icirtudy. 0 • Lp..4., - 4.4 r4S zetieggis . 1:2 4 tit.. ~ice erg can ‘‘%eag 4J• /44Jeltt tirlVdttf. , V1.4^^.: er tie %re "*Irt * Jr SI, he, • .6 e f cocervig:-.Craeln !r014 v ry.fri.< CC aa. yew- Mews 0• L▪ eer •• •••••. ~, s. ikC..*.4 :0 De , 4443 i•l:P4C44 ANifftgla C LI, 3...SC 4'. ~Peg :n fr T4r4 et n. u$40•0 iø.r 3464r A Wier ..‘11Pri C• It 0. I kr4 5~0.4 know. Z •erk. show ~fell•• .1~ 4 i.1010" .41.0 • 'h twehe- "hi De."‘ k ~aka 'elk a kcal. Ol• p44«,0444% CCTS•Ply aø4 •h.eque•0 kl De PhDs n. W.'41.44 - 4'r, .k5D4e: L' • Ca4•10 Pte . J414r :Ye trNir 4 f4.1fr: crow% 'NB, h Iata r - thank rev :4: one dime'. Met car; 0,40e• mri.T555 2S% p. hcrf.C1 tkeh.:, *perk" haepany yte. e. wee- mho • 4t)pør 411,1 ▪ 0.0‘f “tod It 4 1k3 r 4 , 41•ShNeflerkelInah A, ' , ken alit Fer.i saf•Dr al a akSC- NR n 0. ••• mien • am. ahte •D's v.% I rvin fa. 0,0.411. :0 Len prop. gatene .4, -1. ac.zhnt ..eitel t ktefitut 04- 4•141.4 4t corn44,4 Vat G. «Mr 44.."4 444:, al V the gX444,.. 'fli•Titi cc Tucce..' ezede cim • ;Mel tenon r ?coign rn a -5' altlertlk3 kthOn" ."• • • .••• C'tW n-cie For Entioe~l you 1~1 *ay 04 hens 1.4)~ (ce) eficive. you may mil be *foible le pertinpetai in *few bea m it you 14441./ on4 of the eatinkooks Meted knekr 'NW knew* twipoont' at the back DI dl. ~Ion Akron" If ah pleat ~ly the tterrehon ~its 11 0vough IC) here ~vein 1(b) h not avakableY NOTE. cesaptione an, na sppikeete fw IMi.wMut r•threkint haunt.. ifidi~ig a toet aktoun4 teal* e• MINA 4440.al6 wMich are treated e inturS person, fa d.å purpos• Private end Confidential 8 SDNY_GM_00020466 CONFIDENTIAL EFTA_00131086 EFTA01273293 Investor Application Form (continued) G. Certification Regarding Initial Public Equity Offerings (contact): Rule 5131 'Covered Persons' (1) Please Initial below if applicable a if the timber is a corporation, partnership, trust or other entity, which apply to any person having a Beneficial hfferest In the Investor The Investor, a any person having a Beneficial Interest in the Investor, is (0 an executive officer or director of a Putfic Company et a Covered No-Pubk Company. or (II) a person recemng Material Support by an executive officer or &ecta of a Pubic Company a a Covered Non•Pubhc Company (any person in 0 or (11a -5131 Covered Person'). (2) If you iritialed statement (1) above. you must name each relevant Pubk Company ander Covered Non-Public Company: (3) If you labeled statement (1) above, please initial the following only if such appricabk PublX Company or Covered Non-Public Company:. (a) is currently a client receiving Investment Banking Services crowded by a FINRA member, or has paid compensation to a FINRA member for Investment Banking Services in the past 12 months; (b) expects to retain a FORA member for Investment Banking Services within the next 3 months; or (c) has entered into an express or impbed obligation. drecdy or indirectly through its executive officers or directors. to retain a I NRA member for the performance of future Investment Banking Services. If you Initialed any of hams (a) through (4 above, you may still be ellgibk to parddpate in 'new issues" if you satisfy one of the exemptions listed under 'New issues Exemptions' et the back of the Subscription Agreement. ff so, please specify the exemption number here (exemption 1(a) is not available): If the Investor has represented that he, she or it is not a 'Restricted Person" or a 'Covered Person', the Investor further represents that he, she or it understands that this certificate expires after one year and agrees promptly to notify the Fund should the account become a 'Restricted Person' or "Covered Perron'. H. Government Entity Status 0) Is the Investor a Government Entity? 13 Yes (i) the Investor is acting as agent representative or nominee for one or more investors, is any of such investors a Government Entity? ❑ Yes tf<do (ID If the answer to question (IC Is 'Yes', please indicate the names of any such investor: ML281817-MAXWELL Private and Confidential 9 SDNY_GM_00020467 CONFIDENTIAL EFTA_00 I 31087 EFTA01273294 Investor Application Form (continued) 1. NFA 8 slaw 1101 CortifiCation (Moan •110614••1940041 441. nada IRA as Rsuadaion Mantas. - yvtate aseasnm are Arbil% WI AMA. 40. Y • mosACIA, 6.4u-4144 rot revzsr.• to e• . n ebt a re re ASSOC.We • NIA •• x M Or MOSAViasonit Ma: cA1nOC,A ( Owe, Nene ( Orr' ••.: • ON soca 11, "not <Vita. &lee kat. VW'S* Aatadf/07Me OR AR (gat Entry ImeitOrs: :e fe 14 / 17.7 '7 , t4e riviVet $ a consmorals ANY rs• Oartalr• a-•••••• •ttassn- a Vew a• 'eo- Dr f.;• Me NIA re :0 0, •eworecl <f'! 04r, Ir R▪ isaal nova *Me nos •1••••Sela can, gessially. CALM pirate arnestasent vaiacies sods as tingle ntembirt casapanias and amain fl ied sionneskins ov ossestisol ionlY amosbor% woe *then Amid initial this make awl Wow if appliabia) ' ("Ant. •• • 9ur I at : ^vIV , e• ,t a...1 • loan,.•ens .0, set. tovseel•V's 7.-47 , 4 'att.:. ettlftett: MI%:It 00135,04PITSIANIS •-•Z•othe Sri 'Mufti, :aster .11•41.1 17.731msent, aNS 71.47), :' nat. • a lanr WO 404 VA kW • nonce rata Vie -tar actcnsetta• :2-1' e441M . '414 sao' ; ,90 .rg.trele kis 4 '3 an:1Na 'ice • 1.0t4. slif oitTalain val•Irve ''t • ". arhe'•• 'r ..ate an est aca 7017 sr Otintwal Awssaa A pat whoa are,. • eu • 44 4,2 4es •••• a -070 )10•7 0710 4.7.7*NFA t - • 'Nicer 1 a canconlatumn W " I termaitsv 2010.04 btt pen a 9 70...e. n. as ••• • •••0010.• Wi• '•'• :4-vet l CAP .7* cart'. pan CZYtee :Per 7. I M010••• 4•7CP1M.7 !Nam. Sasecy A.' id 1974 . Nnine '0.41b SF airy •••17)100. V• )WNW ge ze flow, .IN 7. Cr .1 •ainv• • w*•:• Dec* tee app<4 I •••44ran d'ente L7 .<7.7! lilt C. Maar Mt tin ,{ran rear Pa investor nas atarranaa rim 'flarala .• J / tarlatan PA: nusausr OR tate ea so MA Miabets allot Soso relied so noisy we So OTC • .e.yeur, •I 44 MO* -t •41:InteaCY POO ng ',wow •••••••71.1bele worse pot 14 • " 0777. 1 .• NSA m9111404..7 ere: r•C Mr "4 DIOS :le •'40• ly e. *am w levralu• aIn Verc.IK• "pall. I laiplefel aOrnevall .u o °Weed. Ze.777,,My .43, ea:•at Isthses ma•naaan fresthar• YMOCurgla breeq• Y..Ll icee4r. .„,.9t no. "V411'eat t 411. 9 4• 4 aa'd : 410K1 ' ••• Of Ito.. Ma •04Cli, •If Wnbta ao P07.77 0, waplOsAt WrIriagS at9f. v Cora WI 'es '. a? 73 bee:" WI • is Arran one Coolies. Iv SONY_GM_00020468 CONFIDENTIAL EFTA_00131088 EFTA01273295  Investor Application Form (continued) 1. Investor Adintewledshesent 'n• ,.•vsenornej .!CA. win, j • 5, ann. ea, we • :11. a Man am ertaraa 24 a 24 h/ fifth aiSen Ip 02•COSes :JS Naha tdIgrien J The Undelnigned terattentl diet S. the or it m e hatted States person' (as such in is definer' in the Cede) kr purposes a U.S. federal income taxation and has provided to UK ..pfd and duly cerepieled Conn V4.9. Or wawa form th ereto. signed wider pethiltas a fithlthY by such Undersigned. th e Unledelgerad Cilrillsos under penethes of WM" that (AI its U.S. taxpayer • p -P r a• !'; ;On fo "WC...CC . 0 idereilketion isamber, as it egpesra In the investor Appiation Forth ie this Subscription booklet. is * . PM Ube and correct and ill0 it es NOT pawl to backup VatItt#80161, twat.* either Mile CRAMP( th en beau' , lintlt athleg. ha not berm sobbed by the U.S. Internal Revenue. See** l'IRS1 that it is militia to baby tuthholdng as a mutt of • lath to report ea theorist a dividend .. or (3) the Its has notified it thanes no kompn subject to backup withholdena. The UndeSegned YOU natty the Fund within IS days rf an y of the above anifeatioin are no long*. raid. Upon aquae by the Fund Uthla. the Undersigned Well proreptly funtob to the Fund said and duly tompithed Foam W.f. Cot tur<ewo lean Memo signed under penalthe el paigury by suds undenignod. Ire nets Ted :as Wt.., confanso a dt fM ciamthon Itly04121 Umbra:de as Canton it 7.7; the: aa. al t wo .florstatass Mei tillidaad le be DIMM.0 Ow !le 4P INS fl ee. ACIIIIKAtet • eau few% ion "a. eiOeet Inc (MOW* .• a. •••••3 : he 000.84.011O3 Nefeltehtt of lot 4 On 'etre:. .Mlatlry Vas SC on be Mee by Ire ArtaTeett Aram IV crodriputs er.atr O&M ONC