Text extracted via OCR from the original document. May contain errors from the scanning process.
UBS
UBS Financial Services Inc.
Account Number
PWM Office
Power of Attorney (PWM)
(Not for use when naming a professional Investment Advisor)
Private Wealth Advisor
1
0
00 :ouni
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
future*
•
•
• this nil confirm the authority of Daniel Kesner
(Agent Name)
to perform each of the actions initialed below and to take any and all 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 '1*. or 'me' or 'my' refer to each of the client(s)/principaRs), individual(s) or entn(es), that
tea
executes this Power of Attorney.
•
ach client must Initial in the box next to each agency granted. PLEASE SEE IMPORTANT DISCLOSURES REGARDING TRADING
AUTHORIZATION FOR (IBS PACE AND STRATEGIC ADVISOR ACCOUNTS ON PAGES 2 NC 3.
Trading Authorization
initial here to authorize my Agent to enter orders with you to purchase and sell securities and simile/ 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
L
I initial here to authorize my Agent to enroll my account in any investment advisory program offered by U8S, 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
-
1 I initial here to authorize my Agent to instruct U8$ 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 correction 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
r
J
I 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/3, as applicable. and any related doelonents
Duplicate Account Information Authorization
I initial here to authorise my Agent to receive a duplicate copy of all confirmations, statements and other communications.
Multiple Agents
If 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. R
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 designated agents.
Sign this section d you intend that multiple agents must act jointly. Unless signed below. you authorize each agent to act separately.
If I have designated more than one agent for my accounts, I direct that 085 Financial Services Inc. act only upon the joint instructions of all
desianated agents.
Ill
Client First Name
Last Name
Signature
Date
AC-MI (Rev. 12/14)
CNN
02014 UBS Financial Services Inc All gilts eserved Member SIPC
c'•trie I
CONFIDENTIAL
UBSTERRAMAR00000905
EFTA00236578
UBS
Agreement
By signing below. I agree to indemnify and hold harmless LABS and its affiliates and all of their employees and agents from and against any and
all claims that may arise by reason of UBS having relied on the provisions of this onstrurnent I acknowledge and agree that my agent is
authorized to make any trade for which my account is eligible or approved. including margin trades and short sales and to receive any and all
account information thereby 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 UBS or in any other document).
UBS rs entitled to rely on this Power of Attorney until written notice of its 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 required 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 agentrattornepirefect 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.
II Power of Attorney is granted on behalf of an entity (e.g trust), please provide the client names) 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 principa
component of the services clients pay for in these programs. As such, clients may not designate a Power of Attorney for the purpose o
. . . . . Obtaining investment advice on a UBS PACE/Strategic Advisor account This includes registered or unregistered investment advisors
• ' . • • "
• iiensItants, financial planners or similar parties.
C16114 ar
Witness First Name
last Name
SIgnatute
. .
. pliMI must sign and date in the presence of a witness who must also sign and date this form.
Ghislaine
Client First Name
Signature
Date
Client Fast Name
Last Name
Signature
Date
thv:Pfesence of (cannot be the Agent):
•
•
•
•
•
.
Date
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 PACF/Stratega Advisor account This includes registered or unregistered investment advisors,
consultants, 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
0
Daniel
Kesner
Agent First Name
AC•MZ (Rev. 12/I4)
CONFIDENTIAL
Last Name
Signature
Dale
02014 UBS Financial Services Inc All ghts reserved. Member SIPC.
Page 2/3
UBSTERRAMAR00000906
EFTA00236579
UBS
Home phone
ADDITIONAL INFORMATION (To Be Completed by Agent)
Basic Information
K
Check here if agent is UBS Financial Advisor or a registered associated person at UBS
Daniel
Kesner
Agent First Name
Middle Name
Last Name
Country of Citizenship.
•
USA
K Other: (specify)
Pa
r
•
SSN
a'"•ess line 2
United States of America
tate/Province
Zip/Postal Code
Country
Agent's Relationship, If Any, to Principal
Agent's Account No. With U8S (If Any)
Financial Information
Investment Experience: How many years have you held investment accounts) 20
years
Which best describes you' knowledge of investments? K I knot/ very little about financial markets and market investments
•
I have a good understanding of financial markets and market investments
K I am an experienced investor in financial markets and market investments.
Personal Information
Date of Beth Milt
Is the Agent affiliated with any securities firm, excluding UBS and its affiliates, broker/dealer subsidiary of a financial institution, securities or
commodities exchange, sell-regulatory organization or the 1/85 auditor (currently Ernst 8 Young)? (NYSE Rule 407)
Z No
K Yes Of blank, Firm assumes No). If yes. specify affiliated firriVorganization.
If you answer 'yes' to the NYSE Rule 407 question, approval must be obtained from the specified film/organizatiOn before the account can be
opened or trading authority becomes effective.
Is the Agent an employee or related to an employee of UBS AG, its subsidanes or affiliates (e. g., UBS Financial Services Inc UBS Secunties DX)?
Z No
K
Yes . specify Affiliate/Subsidiary
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):
Z
Employed K
Self-Employed K Student K Retired K Self-Supported 0
Volunteer K
Unemployed K
Work in the Home
Other
Occupation
Business Phone(optional)
Business Fax (optional)
Marks Paneth
Other
Employer Name
, Construction, Service, etc) (optional)
ine
ess Line 2
United States of America
ity
State/Province
Zip/Postai Code
Country
AC-MZ (Rev 12/14)
O2014 UBS Financial Services inc. All sights eserved Member SIPC
Page 3/3
rnNFIIIFNTIAI.
UBSTERFtAMAR00000907
EFTA00236580