Text extracted via OCR from the original document. May contain errors from the scanning process.
SUBS
MOS Financial Services Inc
ific.aiunt
PWMOtkn
_
-
-
Pon!. Wealth Ayy,ita
Power of Attorney (PWM)
(Not for use when naming a professional Investment Advisor)
OCco..mi Mame
rubel he...Halal,
aoltintitaliOn agar MAO &cowl. At us% lei010.1 Sane, me n int woo name ocrethei <Amenity open Ot opened m
lulus,
tie
Moswelconhnn the aulliailv 01
r_eStie(
(Apia Mai
io pc."--fom, tact, anne saws vittsge0 bees and to take ally and all anon neCtistai ta a modentof to coition Cu' WC° aorm"gilhon't
IsChAing the etteCut.On Of documents a lams a Ohre at.teCetta10,
MOW When shoo in this clocunhint the saes
ow" a 'my' feta go cacti of the tM
sepenctpatt, Jseksselualls: a ("Want. Ilse
executes its POVIet of Altana
deed nal
initial in the box next to each agency guatiled. PLEASE SEE IWORIAN1 IPSO tOSuRIS REGARDING TRADING
• AulmONZATION FOR ORS PACE MO STRATEGIC A0vKOR ACCOUNTS ON PAGES 2 ANO 3
' Trading Authorization
initial ANC to thltnCli)* my Agynt b NON VOWS With you 10 P.I.these eV tact Weurifiet ana Sendai reepetty ,.mtltAng Options
er.ponat.041%;. nm atoll:large Witt OM qualitcatorli NOON and VMS Wm, and ConOitiOns lot my accosi s,. at bon.ers
leek, ' etImola my own MC cacao,. or as Orbit t1 lu mono othim [arson
t•
Managed Account Authorization
rein
a0thocie my Agent to emelt my account to1 any tewestment soon/ picgtam *title." by ues. to mecum me
investment AbeM1001 Tietatiaishoo Agttitment a agoOlabte tams. and spec/Iv* to Me and wombat. elsoeicegary and not
discretionary inyeitMent managers I unitkcStancl that the tohtsont Retaliating) Ogleememl. Myth., en< wed by me a my Ageni
4c0y 10 all ilttS atSchay parent accounts that I may open os the luitee
Dishurstirmint Authorizations
Wt.)r
mil W Piece to aulhine my Agent to chew? ORS to tlatillet money a annum to accounts held in my name Of IV my ben. lit
moo to mate
osthnoccting et tides CO my bona at comedian rem any llama/ atehotento uncie. trio Cower of Attorney Such
Igniter. may OP ohm tea by MrthOcIS which "loge ad are not wooed to esiai hal motel item
oectiocic finds 0 OW*. M
Chats
tax docianants Authonzation
moil hem to auttionce my Agent to make. eatiCule and µHit la lams, axtochnh seithool Immfahcc aY VS woeful Rnenue
>e we folios We and W4. as .1000athe. anet ant 1(14110 date tints
Duplicate Ottawa; inStamation Authorizatkm
41.14.0 tithe to autnocce my Agent 10 recent a &sonata ropy a d
statements ea other ratrrtunc nobs
Agants
nave neitgAlk`b MO*. agents to ad On my aCCounOtes lot NI that each agent 5 &Other/tea ICI act 1.16/padOntly CI any Ott* agent. If
UBS Financial SeriSCA Inc determine. in At tap 6.011.00, hit It li tereenng cOntlittag inittorhons hoen agents mil 1 have designated. I
authwee IBS Financial *ewesInc in its bit Main MUM along mewled fiCim any a my arms unlit Ire tenth( na,OMd mesa at my
be( lid or by my designated agents
,On ton Woof, APpu mend ter bsuibLvt mem must mrholndy Unk53 SaW OS*. Sal surly:neat agent to me tapataly
r
nave oesloated mx• than ale agent foe my A(04/111. dyed that teS Financial Seine. Inc act only igion the rant eittiations Of al
JewinMeu agents
IN
Chamilint Name
ant Name
AC .M7 :Rev IMES;
020t4 uBS Final& Servo.,
*piston
late
mminirinChITIAI
UBSTERRAMAR00000788
EFTA00236477
(*) UBS
Agfornorit
Ry Nomen Dekt. I n*.
to endemnify and riOtd haernlevt OM and dl Mohairi and all Ot ISW ~Kl
anti ageni5 I: om and arm,
any ani
Al darm% that may ante Oy enten o1 ulteS honnig 'Sen nn tne flOvniOnS ot dm enilturnent satirowleOge ion agree Mat my teert .s
authOteitd tO mate any ni«
tor want] my atcOun: is elrbe a afwrong. mooding magn 'facies arm Woei wies ma :0 Wette any and al'
« Stront rnfOrfnaleur I hettlOy tany.<0Miltri sid agat IJ OP ~Kl
Oy any and at Ifinetburs.lradén or rangs Medio aflaten <X verba&
effinwo in and ta nv accOunttS; by my aplInl th COOrn.1.00 enm In autliceiy waren, in ind instrument aan«).
Out rol eenden to the
eirrutiOn Ol da omegt' forms or agreenores or any aultsyrialions d 1 ham mstoucle4 Pst Oss Pater ol Altorner oe Arcerecl in a Trutl or
(konen Serwe Annurd. I ermiressly acknowledge and snee Mat ty sgoing below I Gelegd* in. Wrap.% ontroer 1 have as Trustee or
Office.. Member.
. Partner aOthtli rtOteléntaleye dWy aUltoOrOnt. arm uyin dut etal ut
el noch reOtentyntalnt hinnety
ahatIlle• aN aPhld•It
hitit
the accounts ki Mom Ihn tahoe/MI.0n aneithin
Inl. :Wang of AIR/0nm wal beloer° :o. <Ontrollen by and rob/peter; rn a<tadanc. Wan Om UW> 0.!
Stal. W New York. nntleOut nortnn
enecl lo any Oneer" Cd <Mr. ot law no conflui 0/ Ina InOlyhtMlandn) ana tetnevon IO Int tonitaty tOntoned en eng applhatho tor any
actOunt at CAS or in arn ome. docurnem:
INS .5 entriko to 'Sv On Ibis ~ei of Arme, rein roten nome of in gevangi n owyereo ro air beanch ollne ~el,
1M .(<0.ont
~ford
arm tempi
acknonletdded br Vin grwollment In dieratkeislny WIS Moest:~
Achisonr programs wit Tor thOse
Mcounts. Immediatify and effietively moge any traden authonation gramod Mankt in ~Won
somp of thy wfwas yen have
*Ms"
abn'
SuM•cl lo IdndanCen cn thee ArarbOMY aferboire0 <Y Iscr. rergasOn rure or Out prots
ano und!' non orturmlarxes.
ta°
VphIpt may be lennenaled 01 ~glad m tIBS' loge nnoetton tor trarnple.
Finandal Advisers ~not be ~MMS %OS of
Attomey in any retiremint account
nos is an important legal document Betont enrcuting tes document you thould asos these nipt:alant teert'
•
Th,. document —y prOvode th* person yOu dissignine as your agentattorney-rn-frut witti berd pesoen. rotloding POwar to
Inallapit Wl. despose of trassen in your account w borrow money ming voor ~party
es inunly lor dm loen.
•
el you are wing Mis Power of Atomry in • Ratirement Account you s0Ø no amore tint Ine agent 18 not cusnonsed undes
this document to mate or Mango beneficiary designations ot] your acCount.
• ' ,met ot Alle",
n "AOW' On wend of al eind, e o unit. £#ase pont
We <bent nanse:s. sno nut dinar n inttexhitaltn el lbo
hert? • g 'al Puien':
ifAKMTANT OPTICI POR PACEMTRATEGK AD4/5011 ACCOUNTS: Oroong Mare trom Me :An /manou ~mor n • concOaff
ornuonent of Trit Wint" <bents pay 10, in these prOgonn As su" r bent. In« nOt donna* a PM*, ot AfforMY lot Ine ~Min
Ol !
nmenmg trweitfenill miste an a LIAS PAU/Water
ACRO1414 «room ins ,nitides regestered or onferinterecl ~rent
annh-
tants. lereargial ~10101
lantdat mam
(-11.1tSiC4e.
1-viMen
(tem fint enne
tal Name
;heisiest NO»
...w.c. ot Canto: II. IhP Agent
tb\
eJA
'flitness f n st Nann•
last Nor
sy w.
—
Dar
Syretyr.
Pli_ra
2.
22S::›
last Name
~bei
Cases muft Sr
and dato in th* menene of a wimess mto mrt Mosign and date Mis Soms
Dra.
%t
t -
-Vr
gace
IMPORTANT NOTICE FOR PACE/STRATEMC ADVITOR ACCOUNTS: Oreer.; advent fl Om th! as
/Mantra' Arsof
n a wincoall
COMonnen1 Of Pie sennon dab
pay k• In liftte naprann AS wtn. dna may not clinaltnal/ a brr
of nnbioney ta Ina Duimt* olj
obtammg investmern acNrce en J IRS MCE/Stfater hrknn aCtnn Ihn onnudin tartend
De unligriteted hylharhin doMOIS.I
rompetaph, snanoal prooien or wrat parties Ry Nonmg [Wow. I «intern tnai t an not worrilrg ~Omen: e
or tOnlulling wreef to.
hitl pi inloop wie apoitty Pre Int aCCOunl
. _
Oc_mgi
V-PSnri
Arnt hist Plan
tast Name
A. MI :om 12/14,
02D:
futaned Sennas
rros rewryw bou<byi sak
041P
nnntcfllchlTlGl
UBSTERRAMAR00000789
EFTA00236478
UBS
AODMONAL INFORMATION (To Be Completed by Agent)
Basic Information
E. Check here if agent is 1.185 Financial Advisor or a registered associated person at UBS
K-ESnete
It
Agent Mai
Middle Name
last Name
Country of Citizenship
USA
K
Other (specify)
Passpoil/Cedula
SSN
Address Line 1
City
Address line 2
United States of America
State/Province
Zip/Postal Code
Country
Home phone
Agent's Relationship. If Any, to Principal
Agent's Account No With UBS Of Any;
Financial Information
Investment Experience: How many years have you held investment accounts,
years
Which best describes your knowledge of investments., C i know very little about financial markets and market investments
-
I have a good understanding of financial markets and market investments
-
I am an emenenced investor in financial markets and market investments
Personal information
Date of Birth
*f,
Is the Agent affiliated with any securities firm, excluding U8S and its affifiates, biokeddeiler subudiaiy of a financial institution, securities or
commodities exchange. self-regulatory organization or the UBS auditor (cut:tinny Ernst B Young), (NYSE Rule 407)
C No
C I Yes bI blank. Firm assumes No) If S. SOWN aflihaied finVorganuation
If you answer 'yes' to the NYSE Rule 407 question. approval must be obtained from the specified haniorganization before the account can be
went° or trading authority becomes effective
Is the Agent an employee or related to an employee of UBS AG. its subsidiaries or affiliates le g, UBS Financial Services Inc U85 Securities 1.1.0 )
9 No
K yes . specify Alf ilia leSUbSidialy
Employee Fail Name
Last Name
SW
Employment Information
Occupation. Employer Name and Address are only required il your employment status is 'employed' or 'self-employed'
Status (select one:
C
Employed LI Self.Employed C Student 9
Retired 5 Self•Supponed 5
Volunteer 9
Unemployed C
Work in the Home
Occupation
Busmen Phone (00henal)
Business Fax (oPtiOnal)
Employer Name
kit uStry Ice, Construction. setvice. etcl (optional)
Address Line 1
Address Line 2
City
AC•M2 )Rev 12/14)
State/Province
Diatoms' Code
nay
02014 U8S Financial Senvlceslnc.AY oh ts @serve° Member SIPC
Page 3/3
rnntctllCNTt At
UBSTERFtAMAR00000790
EFTA00236479