EFTA00238535.pdf

UBS Financial Services Inc. UBS Account Number 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 UEIS to initiate withdrawals from an external account, please complete the information below and attach a voided check (for checking account) or a deposit slip (for savings accounts). If neither is available a client 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 RouUrg Number Account Number Account Type: ❑ Savings Cgl 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 UBS to initiate upon instructions from authorized persons. Instructions may be given through a UBS representative, 1)85 Resource Line, U8S Oran, Services or this form subject to verification (8100,O30 maximum via ResourceLine. $1.000,000 maximum via UBS Online Services) Cgi Deposit to External Account ❑ Withdraw from External Account Oncluding Withdrawals to Pay 085 Cr.* Card) Permissions for other 1385 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 Title/Name Internal Account Permission: (select all that apply) Deposit to authorized internal account ❑ Withdraw from authorized internal account Allow UBS to Initiate 'On Demand" Transfers to or from Accounts upon Verbal Authorisation: By signing below, you authorize OBS 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. ❑ 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 Fisted 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 selected1Ofthat account NU out the below for reaming transfer/payment instructions Payment Type Starting Process End Date Frequency Amount Bank or RMA Account Date Number Account Title 0199988095 gni •.,11 fel AC-FT (Rev. 09/16) 02016 U8S Financial Services Inc. All ights eserved. Member SIPC. Page 1/4 CONFIDENTIAL UBSTERRAMAR00003147 EFTA00238535  UBS Payment Type Starting Process End Date Frequency Amount Bank or RMA Account Oate Number Account Title All out the below for one-time 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• horn your External or Internal account or 'D' deposit to your External account or "P" Tor withdrawals to pay your UBScredit card. Payment type must be indicated for each transaction. Starting Process Date—Enter the Process Date that the Deposit/Withdrawal/Credit Card Payment should be initiated. For recurring withdrawals to pay your UBS credit card, valid Process Dates are between the 10th and 2CM of the month. End Date—Enter an end date for the final 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 depositedNathdrawn for each instruction listed. For withdrawals to pay your UBS credit card enter Statement Balance, Minimum Due, or a Toed dollar amount' Bank or RMA Account Number—Indicate the bank /credit union account number 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 trek cart 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. 0199988095 AC-FT (Rev. 09/16) O2016 UBS Financial Services Inc All rights eserved. Member SIPC. Page ../4 CONFIDENTIAL UBSTERFtAMAR00003148 EFTA00238536  UBS Client Authorization 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 accounts) listed above, and authorize the depository(ies) named on my authorized External Accounts) 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. I further acknowledge that electronic funds transfers under this authorization may be processed as automated clearing house (ACH) debit and credit entries. I understand when I authorize a withdrawal from an authorized external account to pay my U8S credit card, UBS Financial Services will initiate an electronic funds transfer from my authorized external account and make a bill payment to 085 Bank USA. I understand those instructions will remain in effect until UBS Financial Services, Inc. has received written notification from me of termination or modification in such time and manner as to afford UBS Financial Services. Inc. a reasonable opportunity to act on it. Inclose or change any account listed above. I will promptly notify UBS Financial Services Inc. of this change. I authorize U8S 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. 14-16(... M A sX frviE )re Account Holder First Name Last Name Account Holder Signature Date * Account Holder First Name Last Name Account Holder Signature Date 019998809S AC•FT (Rev. 09/16) O2016 UBS Financial Services Inc. All rights eserved. Member SIPC. Page 3 4 CONFIDENTIAL UBSTERRAMAR00003149 EFTA00238537  UBS Please attach a voided or cancelled check here If a voided check is not available. provide a client statement or letter on bank stationery confirming account title, account number, and ABA routing number. NOTE: In order to initiate withdrawals from an external account, the account tides and ownership must match. If the external account is titled differently, a signed Letter of Authorization from all other account holders is required. AC-FT (Rev. 09/16; 02016 06S Financial Services Inc All rights reserved. Member SIPC. Page 4/4 CONFIDENTIAL UBSTERFtAMAR00003150 EFTA00238538