Structured Products Agreement and Approval Form

Structured Products Agreement and Approval Form Please Complete All Sections Accoutki Account Ham; WIG - o 2 33,c)li sfx, ilerS-t K) N A/Qc AL LL c_. Account Type arin.v•Phil ($9004). !aMtivilltital.:yetroluity I.w loralion NOTE: IRA and ERISA accounts are prohibited from purchasing Structured Products. Account and Owner Information: Provide requested inhumation for each beneticial account owner (tong. If more than one owner exists. !ha Structured Products Agreement and AppiovaiSuroontentary Form to this Agreement may be tequired. loot; Nanµ. Malelle. Lan Name nl IntImdua Teu.iev el El.:cuInt -re--CP2.€-_•`1 G 9 51-6- I JJ ndtven I cic) Rco 1-V ic) \< c&k\ONet 132 CnUntrY US VW..G‘s. s-r -rNotAAS Ilvil•Uni nt 0rpendetitc MA, nal Sialirs S\)/ - MfaCOlrf vv of CmCgOvN SGL4 Pus. Pngiv• Invest Dann> Pennon VoNS I tell 410 pcovccrics owNet (0* lioatal S) a! Ira , aa(S) atlag !Km httatial OWlia, (51 MilltDoitd to Pl3C0 Orders los t he account L "kR2Y-C