EFTA Document EFTA01273264

Signature Page Ghisialne Maxwell Account Number and Description z Signature Requirement By signing below and depositing cash or securities in my account, I acknowledge that I have read, understand and agree with the enclosed UBS Client Relationship Agreement, as well as the terms, conditions and disclosures in the Agreements and Disclosures booklet that I previously received, IRA Benefldary Designation By signing below, I designate the beneficiary or beneficiaries that appear on the enclosed Account information pages. Employer Retirement Plan Rollovers For fOlloVPIS born an employees retirement darn I have reviewed the options available and evaluated the Investment and non-investment considerations described in the IRA Rollover Disclosure avallabe In the Agreements and Disclosures booklet; I understand the fees and costs associated with IRA and I have made the decision to roll over my assets to a UBS IRA independently. I also understand that if UBS provides services to my employees retirement plan, none of the information provided to me by MIS or its employees about rolhng over to an IRA was provided as part of any existing fiduciary relationship to the plan under ERISA and that neither UBS nor its employees acted as an ERISA fiduciary in supplying such information. Electronic Delivery Consent As you requested, we have sent your agreements and disclosure booklet and other account-related documents electronically to which we consider to be the e-mall address of record or all owners of the account. The Information is also available at www.ubs.com/accountdisdosures or by request to your financial Advisor. Scott Stedman I Lyle Cavielat 1.212-821.7000. The Client Relationship Agreement contains a pre-dispute arbitration clause located in the final section under the title "Arbitration' PG "slainelMaxwell:On4pir„. -ps...ir,,y1T7.1a-c,ffa/SlalainieaatC .Ii1TriF For Accounts: Y1 23697 Traditional IRA - Sole Owner Date < I ti fly SIGN AND DATE MAL ta LzretzcTITTarTREEEMEZEMEWadeptillfgraltifiFairel&-rA 7, sElwarfelili;spfl'Ea1 -zetatiatlizid S9 6MT WalF,BZ MIN MIN 009463 955 Paget of 1 Ylq 1111111110111 CONFIDENTIAL 11111 SDNY_GM_00020436 San 01 NUMMI ONV NOIS 19 EFTA 00131056 EFTA01273264