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* UBS
Authorized Agent/Dual Signor Addendum
UBS Financial Services Inc.
Account Number
TIN
to add an additional check user on the Resource Management Account' (RMA') or Business Sennces Account est, complete the Authorized
Agent for RWVBussriess Services Account BSA Check Writing and the Account Holder Certification sections To remove an authorized agent,
complete the Authorized Agent Removal and the Account Holder Certification sections If the dual.signature option is selected on the Account
Application, complete the Oual Signors for RMA/Business Services Account BSA Check Writing and the Account Holder Certification sections
The Account Holder must sign the Account Holder Certification section located on the next page.
Authorized Agent for AMA/Business Services Account BSA Check Writing
Each additional check user who is not a minor. named below is appointed an agent to me, unaffected by my subsequent disability or
incompetence. to effect checking transactions in my designated UBS financial Services inc account As indicated below, the additional check
user is authorized to act on my behalf to write checks for the payment or withdrawal of funds drawn on the designated U8S Financial Services
Inc account or payable to me and bearing the signature or signatures now or hereafter authorized by me without limit as to amount, without
inquiry and without regard to its application LIBS financial Services Inc *11 send all confirmations notices. demands, statements and other
communications regarding checking activity in the designated U8S financial Services Inc account to me UBS financial Services Inc owes no
obligations to additional check users and may. but is not required to. act on instructions or respond to communications from such additional
*kw
users
Agent first Name
Last Name
Dale of Birth
SW
Courtly of Citizenship 2:1 USA
0
Other (specify)
Passpcvt/Cedula
Address Line 1
Address tine 2
United States of Arnerica
City
State/Province
Zip/Postal Code
Count/
Home Phone
Additional fees may apply Please see New Account booklet for details
Sign Here only if adding an authorized agent
Agent First Name
Last Name
Agent Signature
Date
Authorized Agent Removal for RM/VBusinms Services Account BSA Check Writing
It you are removing an authorized agent, please pint the name of the agent you are removing below
Specify Name only it removing an age!):
Agent Ng Name
t ast Name
0123905W3 tom
AP
AC •RW (Rev 12/141
02014 UBS Financial Services In: All nights reserved Member SIPC
Page It.
CONFIDENTIAL
UBSTERRAMAR00000786
EFTA00236475
UBS
Authorized Agent/Dual Signor Addendum
Duel Signors for RMASuumns Services Account BSA Check WriOng
Dualtlagnature checks »grim two signatures at talt times. It you am entraong mete tnan two ugnon ma you would Ye Orse crt the
wrists to be reduded. Cl all limes please Oseo 'Reoutie0" nest to the ognoes name Ow one memo,» ten de a «pguded wig»
you do
nO: »iron» a repo-00 SkysOl. pleat. vacity all 5.9nOis as optional t1
~Mull cleSqniled DelOW n not a U8S !manual Sewn» irk men,
a«ount notrke, authorized agent. pow« Or adOtrity. elf • also COMpAeUt the emhonzed Agent lor RMAAhnutess »Does Account BSA
(hen yyt:ono feat, Wove
(2MKS heft it pOu do NW want VB} !manna! Services Inc CO non new duel new», thinks I (heard you net be respons!» tot
otweeng checkswith dual seralutes U.S nnex
Senneet
not accept single
Ctsw&S
Såra lxsl Niroe
(Mt Name
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gigues
Sign Nen GAN fwilling a Dual Signa
011tronal
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Date
Note: ton must tomsele and Sign a new addendum CO ado. ~ow or »Gan *ai »teas U.S Denton Nan,,ce,
**A ten on the our,'
'N•Otn Oiled HIclenduin lo ~cede eld wince any omit Clentout due true atkIenclurn on he
Account Holder Certification
He owing Chao. I uND1RSTANO AC tatt0t
al ~CABBIE mat .1 i hive 'Mewed MI of In. wingmince (Warned in Mis addendum add
credal* it as tree and actuate and ‘2: U3S ;manna, Seems Inc M1 authOnted Co tees moon the
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led by this 000.enent unlit LIE
Feee.rwe• 'cents Inc t eleven an twined tow» this tynn. reweng of ~etyma IM
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last Name
gv,ouni how., Litt Name
tast Nan.
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ACC
Wee:»1 Segnstare
Date
Account Heide Nara.*
Date
i2»26001
A( ,RIN JO.
02014 LIDS Inancsad Stench ex AM røqnhnryovni Memeet
UBSTERRAMAR00000787
mneiC reChIT SI
EFTA00236476