EFTA00236323.pdf

• • • B.A 4,M • HAL YASNv ASSET MANAGFNAFNT Atlas Enhanced Fund, L.P. Investor Application Form Investor(s) Please: • Complete the Investor Application Form and return this entire Subscription Booklet to your Financial Advisor. • Only fully completed Subscription Booklets (no faxes, no copies) will be accepted. • DO NOT TEAR OUT PAGES. • Retain a copy for your files. • Read the Fund's Memorandum and the Subscription Agreement. Be sure to complete all sections of the Investor Application Form Financial Advisors/Branch Managers • Please refer to the Fund Investment Application ("FIA") QuickCard for application submission instructions, or call UBS Alternative Investments US at 888-962-3842, option 1, sub option 4. • Effective July 1, 2014, FATCA compliant W-9s and W-8BENs are required for clients to execute new investments in all Alternative Investments. Please refer to the enclosed Tax Forms and related submission instructions. • All Investor Applications must be submitted on FIA to UBS Alternative Investments US no later than 6 full business days prior to month's end. Private and Confidential 1 CONFIDENTIAL UBSTERRAMAR00000624 EFTA00236323 Instructions for Completing Investor Application Prospective investors in the Atlas Enhanced Fund, L.P. (the 'Fund") should read the Memorandum as well as this Subscription Booklet prior to subscribing. Please complete all sections of the Investor Application Form. If you invest via this Subscription Booklet please promptly return the entire Subscription Booklet to your Financial Advisor. Do not tear out any pages. Retain a copy for your files. Please refer to Schedule 2 for the meanings of the capitalized terms used herein. Please consult your Financial Advisor or call UBS Alternative Investments US for assistance in completing this Investor Application Form. A. Capital Contribution Amount: • Indicate the Capital Contribution applied for (which may be accepted in whole or in part by the Fund). • Provide your Account Number. • Funds must be drawn on an account that corresponds exactly to the name of Undersigned. The Fund may in its sole and absolute discretion accept as your Capital Contribution an amount less than the Capital Contribution applied for herein. CLEARED FUNDS MUST BE IN YOUR ACCOUNT 5 BUSINESS DAYS BEFORE 5 P.M. NEW YORK TIME PRIOR TO MONTH'S END. B. Investor Information: • Provide the Investor's mailing address exactly as it should appear on the address labels. • Include the Investor's state of residence or principal place of business, if applicable, and Social Security/Tax ID Number. • Provide the Investor's email address. C. Accredited Investor Representation: Please read Schedule 1 and check the appropriate box. Generally, an 'accredited investor" has a net worth in excess of $1 million for individuals (together with spouse) or total assets in excess of S5 million for entities. To calculate net worth, exclude the value of your primary residence, and count as a liability any indebtedness secured by that property in excess of the fair market value of that property. if you incurred the debt on your property within 60 days of subscribing for this investment and did not use those funds to purchase that house, you must include the full value of the debt as part of your liabilities. The Investor must certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund, unless otherwise determined by the Fund and/or Manager. EF236556 Private and Confidential 2 CONFIDENTIAL UBSTERRAMAR00000625 EFTA00236324 Instructions for Completing Investor Application (continued) D. Qualified Purchaser Representation: Please read Schedule 1 and check the appropriate boxes. Generally, a "qualified purchaser" must be an individual or beneficiary of an IRA- or participant-directed plan or family trust/entity with at least $5 million in qualified investments or an entity with at least $25 million in qualified investments. The Undersigned must certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund. E. Benefit Plan Investor Status: Please read carefully and check the appropriate box. F. Controlling Person Status: Please read carefully and check the appropriate box. G. Certification Regarding Initial Public Equity Offerings: Please initial and complete all applicable sections. H. Government Entity Status: Please read carefully and check the appropriate box(es). I. NFA Bylaw 1101 Certification: Please read carefully and initial the applicable acknowledgement(s). .I. Investor Acknowledgement Please read the acknowledgements contained in this section carefully, initial the applicable acknowledgements and complete the applicable certification(s). K. Investor Signatures: Please sign. EF236556 Private and Confidential 3 CONFIDENTIAL UBSTERRAMAR00000626 EFTA00236325 Schedule 1 PLEASE REFER TO THE REPRESENTATIONS BELOW IN ORDER TO COMPLETE THE INVESTOR TYPE, ACCREDITED INVESTOR AND QUAUFIED PURCHASER REPRESENTATION QUESTIONS OF THE INVESTOR APPLICATION FORM. ACCREDITED INVESTOR STATUS AND QUALIFIED PURCHASER STATUS The Undersigned must certify that he, she or it is an accredited investor and a qualified purchaser based on the categories listed below. ACCREDITED INVESTOR STATUS I. Individuals, Joint Tenants and IRAs The Undersigned, either individually or together with the Undersigned's spouse, has a net worth• in excess of S1 million. II. Trusts (a) The trust has () total assets in excess of S5 million, (ii) it was not formed for the specific purpose of investing in the Fund, and (IX) its investment in the Fund is effected by a person who has such knowledge and experience in financial and business matters that he or she is capable of evaluating the merits and risks of an investment in the Fund; or (b) Each Grantor of the trust has the power to revoke the trust and regain title to the trust assets, and each grantor is an accredited investor; or (c) The trustee of the trust is a 'bank' as defined in Section 3(aX2) of the Securities Act or a savings and loan association or other institution referred to in Section 3(aX5XA) of the Securities Act. III. Retirement Flans (a) The plan has total assets in excess of S5 million; or (b) Each participant in the plan is an accredited investor; or (c) The plan is participant directed, with investment decisions made solely by persons who are accredited investors; or (4) Investment decisions for the plan are made by a 'plan fiduciary' as defined in Section 3(21) of ERISA Mat is a bank, insurance company, registered investment adviser or savings and loan association. E F236556 IV. Corporations, Partnerships, Limited Liability Companies and Other Entities (a) The Undersigned is a corporation, partnership, limited liability company, Massachusetts or similar business trust, or an organization described in Section 501(cX3) of the Internal Revenue Code of 1986, as amended (the -Code"), not formed for the specific purpose of investing in the Fund, with total assets in excess of S5 million; or (b) Each shareholder, partner, or other equity owner of the Undersigned, as the case might be, is an accredited investor; or (c) The Undersigned is a 'bank' as defined in Section 3(a)(2) of the Securities Act or a 'savings and loan association' or other institution referred to in Section 3(aX5)(A) of the Securities Act, whether acting in its individual or fiduciary capacity; or (d) The Undersigned is a "broker or dealer" registered pursuant to Section 15 of the Securities Exchange Act; or (e) The undersigned is an 'insurance company as defined in Section 2(aX13) of the Securities Act; or (f) The Undersigned is an 'investment company' registered under the Investment Company Act; or (g) The Undersigned is a 'small business investment company' licensed by the U.S. Small Business Administration under Section (301)(c) or (d) of the Small Business investment Act; or (h) The Undersigned is a 'business development company' as defined in Section 2(a)(48) of the Investment Company Act or a 'business development company" defined in Section 202(aX22) of the investment Advisers Ad. Note for Accredited Investor Status: • The term net worth means total assets at fair market value minus total liabilities. To calculate net worth: (i) exclude the fair market value of your primary residence; (ii) count as a liability any indebtedness secured by that property in excess of the fair market value of that property, except that if you incurred that debt on your property within 60 days of subscribing for this investment and did not use those funds to purchase that house, you must include the full value of the debt as part of your liabilities. QUALIFIED PURCHASER STATUS V. Individuals, Joint Tenants and IRAs (as applicable) The Undersigned is a qualified purchaser because he/she (alone, or together with his/her spouse, rf investing jointly) owns not less than S5 million in investments.• • VI. "Family Corporations, 'Family' Foundations, "Family Endowments, 'Family' Partnerships, "Family' Trusts or other 'Family' Entities (a) The Undersigned was not formed for the specific purpose of investing in the Fund, (b) The Undersigned owns not less than S5 million in investments;• • and (c) The Undersigned is owned directly or indirectly by or for (i) two or more natural persons who are (A) related as siblings or spouses (including former spouses), or (B) direct lineal descendants by birth or adoption. (i) spouses of such persons, (iii) the estates of such persons or (iv) foundations, charitable organizations or trusts established by or for the benefit of such persons. VII. Trusts (Other than Trusts that qualify under VI or VIII hereof) (a) The Undersigned was not formed for the specific purpose of investing in the Fund; and (b) The trustee or other authorized person making decisions with respect to the trust, and each Settler or other person who has contributed assets to the trust, is a person described in V, VI, VIII or IX. VIII. Other Entities (a) The Undersigned was not formed for the specific purpose of investing in the Fund; and (b) The Undersigned is an entity, acting for its own account or for the accounts of other qualified purchasers, which in the aggregate owns and invests on a discretionary basis, not less than 125 million in investments.• • Private and Confidential 4 CONFIDENTIAL UBSTERRAMAR00000627 EFTA00236326 Schedule 1 (continued) QUALIFIED PURCHASER STATUS (cont'd) IX. Entities that do not qualify under VI-VIII The Undersigned is a qualified purchaser because each beneficial owner of the Investors securities is a qualified purchaser as described herein. Note: Trusts may not rely on this certification even if all of their beneficiaries are qualified purchasers. X. All Investors that are Entities (a) The Undersigned is not a 3(cX1) or XcX7) Company; or (b) The Undersigned is a Section 3(0(1) or 3(cX7) Company but does not have ANY Pre-April 30 Holders; or (c) The undersigned is a Section 3(0(1) or 3(c)(7) Company and has obtained consent to its treatment as a qualified purchaser from all of its Pre-April 30 Holders. Xl. Investors that checked VI or VII may check XI instead of X The Undersigned has obtained consent to its treatment as a qualified purchaser from all of its trustees, directors a general partners EF236556 XII. Investors that checked X(b) or X(c) must also respond YES or NO to XII Is any direct or indirect beneficial owner of the Undersigned itself a Section 3(01) or 3(c)(7) Company that controls, is controlled by, or is under common control with the Undersigned? If the Undersigned cannot answer NO to XII because it has a control relationship with a beneficial owner that is itself a Section 3(0(1) or 3(CX7) Company. the Undersigned may be required to obtain consent from the security holders of such owner. Notes for Qualified Purchaser Status: • • The term ' investments' means any or all (1) securities (as defined in the Securities Act), except for Control Securities unless otherwise included as described below; (2) futures contracts or options thereon held for investment purposes; (3) physical commocities held for investment purposes; (4) Swaps and other similar financial contracts entered into for investment purpose; (5) real estate held for investment purposes; and (6) cash and cash equivalents held for investment purposes. Control Securities may be included in 'investments' if (A) the issuer of the Control Securities is itself a registered or private investment company or is exempted from the definition of investment company by Rule 3a-6 or Rule 3a-7 under the Investment Company Act, (B) the Control Securities represent securities of an issuer that files reports pursuant to Section 13 or 15(d) of the Securities Exchange Act, (C) the issuer of the Control Securities has a class of securities listed on a designated off -shore securities market under Regulation S under the Securities Act or (D) the issuer of the Control Securities is a private company with shareholders' equity not less than $50 million determined in accordance with generally accepted accounting principles, as reflected in the company's most recent financial statements (provided such financial statements were issued within 16 months of the date of Undersigned's purchase of Interests). NOTE: In determining whether the $5 million a S25 million thresholds are met, investments can be valued at cost or fair market value as of a recent date. If investments have been acquired with indebtedness, the amount of the indebtedness must be deducted in determining whether the threshold has been met Private and Confidential 5 CONFIDENTIAL UBSTERFtAMAR00000628 EFTA00236327 Investor Application Form A. Capital Contribution Applied for: S Note: Your account will be debited for your Capital Contribution plus the Placement Fee of 2% (which may be waived in limited circumstances). A Placement Fee will be in addition to your Capital Contribution. Please see the Investor Acknowledgement section for additional information regarding the Placement Fee. Subscriptions will only be accepted in U.S. Dollars. Account I: (Funds currently aya1able ) B. Investor Information: SSN(Tax Stale/Country. 141 Phone: ID: i & 1 s Li 6) 6 5 Master Rervioncei Pimples Piece of Busman) Date of Birth: 111123121EIECIEDIEIO occupauon, roenctec 1 PreCden-t- The Terramar Pnylect Citizenship: LISel c Nationality: UNA- mr. Mrs. enema Name (Pot name nose name or initial. last name) Caw rums known by eskesesy Investor MCIAM E-maa Ms Miss. Or. Over Fax: 2. 3 S 3 3 MIERIBLUEICICIIIIM A EILENOEMIUMIIIMIIIIIIIIIMMIIM IZIMEINO o nonmEmorao rimummannumm IS Winn A A C. Accredited Investor Representation C heck only one box By executing this Investor Application, the Undersigned certifies that he, she. or it (as applicable) (i) has read and understands the instructions to this Investor Application including. but not limited to, the instructions to calculate the net worth for accredited investors; and (ii) is a 'accredited investor' under Regulation D (generally, net worth in excess of SI million for individuals (together with spouse) or total assets in excess of SS million for entities) and has calculated net worth as required by the instructions in this Investor Application. Please read Schedule 1 and check one appropriate box below. Note that you must be both an accredited investor and a qualified purchaser in order to invest in the Fund. If Investor is an Mclividuab1RArloint Tenant (with Rights of Survivorship), check here. If Investor is a Revocable Trust, check here: O 00a or O 00b or O (Ilk If Investor is an Irrevocable Trust. check here. If Investor is a Participant-Directed Retirement Plan, check here If Investor is Other Retirement Plan. check here. If Investor is a Corporation. Partnership. limited liability Company and Other Entity, check here' O (iQa or O (0)c O (Mc O (III)a or O (ebb or O (Mid • fIV)a cc O (Nib or O (IY)c or O OM or O 01Oe or O (MI or O (Mg or O (IVA Private and Confidential 6 CONFIDENTIAL UBSTERRAMAR00000629 EFTA00236328 Investor Application Form (continued) D. Qualified Purchaser Representation: The Undersigned is a 'qualified purchaser under the Investment Company AU (generally, ins:residuals, beneficiaries of IRA/participant-directed plans, and family/trust entities must own at least $5 maion or more in qualified investments and entities must own and invest at least 525 million in qualified investments). The Undersigned must certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund. Please read Schedule 1 and check the appropriate boxes. Trust entities should read carefully the specific 'qualified purchaser" requirements on Schedule 1, including the requirement ((Or trusts other than trusts relying on certifications in VI and VW) that both the trustee (or other authorized person making decisions with respect to the trust) and each Seaton or other person who has contributed assets to the trust must own at least S5 million in qualified investments. The Undersigned's execution of this Investor Application constitutes certification of the Undersigned's status as a "qualified purchaser • If Investor is an Individual or IRA- or Participant-Directed Retirement Plan, check here. If Investor is a "Family' Corporation, 'Family' Foundation, 'Family' Endowment, "Family' Partnerships, 'Family' Trusts or Other • Famihr Entities, check here. If Investor is a Trust (other than a Trust that qualifies under w or VIII), check here' If Investor is another type of Entity, check here. If Investor is an Entity that does not qualify under WWI check here *Investors that checked X(b) or X(c) must also respond YES or NO to item XV sap O (M)& b and c AND 0 00a or 0 (X)b• or O OW or 0 DE) O (Vlea and b AND 0 (C)a or 0 (X)b• or 0 (X)c• or 0 (XI) O (/II)a and b AND 0 ()Oa or 0 (X)b• or 0 000 or 0 (XI) O 0)0 AND 0 00a or 0 (X)b• or 0 (X)c• or O (X0 'If you chocked 00b or (X)c abaft. CHECK YES OR NO BELOW 0 YES or ONO E. Benefit Plan Investor Status: Please certify, by checking the appropriate box below, whether the Investor is or will be described in any of the farming categories. (1) an "employee benefit plan" (as defined in Section 3(3) of ERISA) that is subject to ERMA, (2) a 'plan" (as defined in Section 4975(eX1) of the Code) that is subject to Section 4975 of the Code; or (3) an entity which is deemed to be a "benefit plan investor or to hold "plan assets" under the Plan Assets Rules by reason of equity investments in such entity by one or more persons described in clause (1) or (2) above. Examples of the foregoing include, among other things, 'Keogh' plans, other tax-qualified retirement plans. IRAs, certain other types of employee benefit plans (and accounts) and entities that are deemed to hold 'plan assets" thereof. Check one. 0 YES or 12I/ NO F. Controlling Person Status: Please certify, by checking the appropriate box below, whether the Investor is or will be described in any of the following categories' (i) a penal or entity that has discretionary authority or control with respect to the assets of the Fund, (ii) a person or entity that provides investment advice for a fee (direct or indirect) with respect to the assets of the Fund, or (w) an •affikate' of a person or entity described in clause (i) or (le above. For purposes of this representation, an 'affiliate' of a person or entity includes any person or entity controlling, controlled by or under common control with the person or entity, including by reason of having the power to exercise a controlling influence over the management or policies of the person or entity. Check one 0 YES or '40 EF236556 Private and Confidential 7 CONFIDENTIAL UBSTERFtAMAR00000630 EFTA00236329 Investor Application Form (continued) G. Certification Regarding Initial Public Equity Offerings: Rule 5130 "Restricted Persons" A-L.:: The Fund may elect got to invest in new issues even if your individual account is eligible for such transactions • • Please initial the appropriate statement. The Undersrgned has initialed those statements below which apply to it or, if the Undersigned is a corporation, partnership, trust or other entity, which apply to any person having a Beneficial Interest in the Undersigned The Investor is any of the following: (a) A FINRA member firm or other broker dealer (b) An officer, director, general partner, associated person o' employee of a FINRA member firm or other Covered Broker Dealer. (C) An agent of a Coveted Broker Dealer if the agent is engaged in the investment banking or securities business. (d) An Immediate Family Member of a person specified in (b) or (c) above, (e) A finder or other person acting in a fiduciary capacity to a Covered Broker Dealer, including attorneys, accountants and financial consultantS, (I) A person whO has the authority to buy or sell securities for a bank, savings and loan institution, insurance company, investment company, investment adviser or Collective Investment Account, (g) An Immediate family Member of a person specified in (e) or (0 above who receives from or provides to such person Material Support; (h) A person listed required to be listed) in Schedule A or Schedule C to Form BD as owning 10% or more of a Covered Broker Dealer; (i) A person listed (or reclined to be listed) in Schedule B or Schedule C of Form BD whose ownership interest is in a person listed in (h). (j) A person that owns directly or indirectly 10% or more of a public reporting company listed (on required to be listed) in Schedule A of Form BD with respect to a Covered Broker Dealer, other than a public company that is listed on a national securities exchange. (k) A person that owns directly or indirectly 25% or more of a public reporting company that rs a person listed in (i) above other than a public company that is listed on a national securities exchange, (I) An Immediate Family Member of a person listed in (h) through (k) above who receives from or provides to such person Material Support, (m) An account (including a corporation, partnership, limited lability company, trust or other entity) in which any of the persons referred to in (a) through (0 above has a Beneficial Interest (any person in (al through (rn). a "5130 Restricted Person") The Investor is none of the above. For Entities only: If you initialed any of items (a) through (m) above, you may still be eligible to participate in "new issues' if you satisfy one of the exemptions listed under 'New Issues Exemptions' at the back of the Subscription Agreement. If so, please specify the exemption number (1 through 10) here (exemption 1(b) is not available): NOTE: Exemptions are not applicable for individual retirement accounts, individual or joint accounts, UGMA or UTMA accounts, which are treated as natural persons for this purpose. Private and Confidential 8 CONFIDENTIAL UBSTERRAMAR00000631 EFTA00236330 Investor Application Form (continued) G. Certification Regarding Initial Public Equity Offerings . . . . . . Rule 5131 "Covered Persons" • • (1) Please initial below if applicable or if the Investor is a corporation, partnership, trust or other entity, which apply to any person having a Beneficial Interest in the Investor The Investor, or any person having a Beneficial Interest in the Investor, is (i) an executive officer or director of a Public Company or a Coveted Non-Public Company, or 1.ii; a person receiving Material Support by an executive officer or director of a Public Company or a Covered NomPublK Company (any person in Wog 0i), a "5131 Covered Person") (2) If you initialed statement (1) above, you must name each relevant Public Company and/or Covered Non-Public Company: (3) II you initialed statement (1) above, please initial the following only if such applicable Public Company or Covered Non-Public Company. (a; is currently a client receiving Investment Banking Services provided by a FINRA member, or has paid compensation to a FINRA member for investment Banking Services in the past 12 months. (b) expects to retain a FINRA member for Investment Banking Services within the next 3 months; or (c) has entered into an express or implied obligation, dowdy or indirectly through its executive officers or directors, to retain a FINRA member for the performanCe of future Investment Banking Services If you initialed any of items (a) through (c) above, you may still be eligible to participate in "new issues' if you satisfy one of the exemptions listed under "New Issues Exemptions' at the back of the Subscription Agreement. If so. please specify the exemption number here (exemption 1(a) is not available): If the Investor has represented that he, she or it is not a "Restricted Person' or a "Covered Person', the Investor further represents that he, she or it understands that this certificate expires after one year and agrees promptly to notify the Fund should the account become a 'Restricted Person' or 'Covered Person'. H. Government Entity Status (0 Is the Investor a Government Entity' K Yes 67 1 o (a) If the Investor is acting as agent, representative or nominee for one or more investors, is any of such investors a Government Entity' K YeS 6/ No If the answer to question is please indicate the names of any such investor EF236556 Private and Confidential 9 CONFIDENTIAL UBSTERRAMAR00000632 EFTA00236331 Investor Application Form (continued) I. NFA Bylaw 1101 Certification (Please initial as appropriate.; Individual, IRA. Joint and Foundation Investors: The Investor represents and warrants that it IS an individual. IRA or a foundation and that it is not required to be a member of the National Futures Association ("NIA") or to be registered with the Commodity Futures trading Commission ("CFTC) in any capacity fPfease continue On f0 Seaton / investor Acknowiedgement) OR (b) (c) All Other Entity Investors: The Investor (or. if the Investor is a commodity pool, the operator thereof) represents and warrants it is not required to be a member of the NM or to be registered with the CFTC in any capacity (Please note, while not always the case, generally, certain private investment vehicle such as single member limited liability companies and certain limited partnerships comprised of family members, among others, should initial this section and below if applicable.) If the Investor a fund or another investment entity and initialed item (b) above, please complete the following The Investor is a family investment vehicle whose participants include only spouses, children, in-laws, grandparents and cousins, or the Investor is a family office and has tiled a notice with the CFTC under No-Action Letter 12-37 the investor relies upon an exemption from registration under CFTC Ride 4.13 and has filed a notice claiming this exemption with the NFA The Investor relies upon an exclusion from the definition of the term "commodity pool operator" under CFTC Rule a 5 and has filed a notice claiming this exemption with the NFA The Investor is a noncontributory plan, a contributory defined benefit plan', a governmental plan, an employee welfare benefit plan, or a church plan covered under the Employee Retirement Income Security Act of 1974 The investor relies upon another exemption or otherwise is not required to register with the CFTC (please indicate below the applicable exemption upon which the Investor relies or indicate the bases upon which the Investor has determined that registration or an exemption is not required) OR Entities that are NFA Members and/or those required to register with the CFTC The Investor (or, if the Investor IS a commodity pool, the operator thereof) represents and warrants that it is a member of the NM and is registered with the CFTC. Please indicate below the capacity in which the Investor for the operator thereof) is registered (commodity pool operator, commodity trading advisor. futures commission merchant, introducing broker, or retail foreign exchange dealer) 1 With respect to any such plan to which an employee may voluntarily contribute, no portion of an employee's contribution is committed as margin ror gsfilltes Or options contracts Private and Confidential 10 CONFIDENTIAL UBSTERRAMAR00000633 EFTA00236332 ri>ilis. i. (k) Initial initial (If joint tenants. both may be required to initial.) • - . . EF236556 Investor Application Form (continued) J. Investor Acknowledgement: The Undersigned should consult its own U S tax advisor if it is uncertain as to whether it n a 'United States person' for purposes of US. federal income taxation (a) Initial htul crt pint tenants. both may be moused to initial.) The Undersigned represents that he, she or it is a "United States person' (as such term is defined in the Code) for purposes of U.S. federal income taxation and has provided to UBS a valid and duly completed Form W-9, or successor form thereto, signed under penalties of perjury by such Undersigned. The Undersigned certifies under penalties of perjury that (A) its U.S. taxpayer identification number, as it appears in the Investor Application Form in this Subscription Booklet, is true and correct and (B) it is NOT subject to backup withholding because either (1) it is exempt from backup withholding, (2) it has not been notified by the U.S. Internal Revenue Service ("IRS") that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (3) the IRS has notified it that it is no longer subject to backup withholding. The Undersigned will notify the Fund within 15 days if any of the above certifications are no longer valid. Upon request by the Fund or the Manager, the Undersigned shall promptly furnish to the Fund valid and duly completed Form W-9, or successor form thereto, signed under penalties of perjury by such Undersigned. (b) The Undersigned has reviewed and confirmed all of the information in the Investor Application and confirms • Initial initial that all of the information that is required to be provided by the Undersigned in this Investor Application is • Ill joint tenants, both may be true, accurate and complete in all respects • remixed to initial I (c) The Undersigned represents that he, she or it has received. carefully read and will be bound by the Agreements. including the pie-dispute arbitration clause which appears in the Subscription Agreement and the Fund Agreement, and agrees that signing below constitutes the execution and receipt of the Agreements. (d) The Undersigned represents that he, she or it has received a copy of the Memorandum, has read it and understands it, and the Undersigned is aware of the Fund's limited provisions on transferability and withdrawal, he, she or it understands that an investment in the Fund involves conflicts of interest, including that the Placement Agent and its affiliates will receive payments from the Investors, the Fund and/or they affiliates based upon the aggregate amount of capital contributions to the Fund (e) The Undersigned confirms that the investment objective and risk profile applicable to the investment in this Fund are respectively, 'capital appreciation* and 'aggressive: ThiS objective and risk profile is applicable only to this investment and may differ from the investment goals and risk tolerance for the overall portfolio and the brokerage account in which this investment is held (F) The Undersigned understands that an investment in the Fund may impact the Undersigned's future liquidity (either long or shorl•term) and represents that the Undersigned's investment goals are consistent with the time frame of the investment. (g) The Investor hereby authorizes (1) the debit of funds, from the UBS account specified herein or any other account maintained for the Subscriber at UBSFS (..6.CCOontS1, any payments required to be made in connection with an investment in the Fund and (2) the credit of any funds to the Subscriber's Accounts, including any distributions made by the Fund (h) The Undersigned understands that the Fund may in its sole and absolute discretion accept as your Capital Contnbution an amount less than the Capital Contribution applied for herein. () The Fund is required periodically to provide information to regulators of exchanges or markets to which it is subject. The Investor acknowledges that UBS Financial Services Inc. and its agents and affiliates may receive requests for information from the Fund to comply with such demands that call for the disclosure of non-public personal information about me that is related or unrelated to my investment in the Fund. The Investor acknowledges and agrees that UBS Financial Services Inc. and its agents and affiliates may disclose such non-public account information in response to such requests. The Investor further acknowledges that the Fund may provide any and all account information relating to my investment in the Fund to IRS Financial Services Inc. and my UBS Financial Services Inc. financial advisor (current or future) (j) The Investor understands the meaning and legal consequences of the representations, warranties, agreements, covenants, and confirmations set out herein and in the Fund's subscription agreement and agrees that the subscription made hereby may be accepted in reliance thereon. The Investor agrees to indemnify and hold harmless UBSFS, including its respective directors, officers, employees and any of its affiliates and service providers (collectively, the 'Indemnified Party') from and against any and all kiss, damage. liability or expense, including costs and attorneys' fees and disbursements, which the Indemnified Party may incur by reason of, or in connection with, any representation or warranty made herein (or in the accompanying Fund's subscription agreement or subscriber information form) not having been true when made. any misrepresentation made by the Subscriber or any faiure by the Subscriber to fulfill any of the covenants or agreements set forth herein, or in the Fund's subscription agreement or subscriber information form or in any other document provided by the Subscriber to the Fund or any of its affiliates. The Undersigned certifies that the United States is his, her or its country of residence or principal place of business (If Undersigned cannot make this certification, please talk to your Financial Advisor about whether you may invest in the Fund.) Private and Confidential 11 CONFIDENTIAL UBSTERRAMAR00000634 EFTA00236333 J. Investor Acknowledgement (=I): S% "flat tabal (If joint tenants. both may be reogared to Mita' ) . • The Undersigned acknowledges that a Placement Fee of 2% of the Capital Contribution will be charged if the Undersigned invests through a brokerage account. However, in limited circumstances the Placement Fee may be waived by the Placement Agent. This Placement Fee is in addition to, and will not reduce, the Undersigned's Capital Contribution. If the Placement Fee is (educed by agreement between the Placement Agent and the Undersigned, then the reduced Placement fee to which the Undersigned has agreed will be reflected on the U85 trade confirmation The Undersigned confirms that the Placement Fee has been discussed with hisTherAts Financial Advisor and any additional questions will be addressed if requested. No Placement Fee is charged if this investment is made through a UBS advisory program (rn) Please check the appropriate box below that most accurately describes the Undersigned flAn individual that is a United States Person (including his or her trusts) ❑An individual that is not a United Slates Person (inclucEng his or her trusts) ❑A broker-dealer CI An InsuranCe company ❑An investment company registered with the U.S. Securities and Exchange Commission ❑A 3(c)(1) or 3(cX7) Company ❑A non-profit ❑A pension plan (excluding a governmental pension plan) ❑A banking or thrift institution (proprietary) ❑A state or municipal Government Entity (excluding a governmental pension plan) ❑A state or municipal governmental pension plan ❑A sovereign wealth fund and foreign official institution K Other (specify). (n) FOR GRANTOR TRUSTS ONLY. If the Undersigned is a grantor trust, the Undersigned acknowledges that any and all grantors of the trust are U.S. persons for U.S. federal income tax purposes (please note grantor trusts with non-U.S. persons as grantors may not invest in this Fund). (o) SCHEDULE K-1 ELECTRONIC DELIVERY CONSENT assent to Reorient) K-1s Electronicalhrs The Fund may, in the General Partner's discretion, elect to furnish Schedule K-1s ("K- Is, to Partners electronically Please indicate whether or not the Subscriber consents to being furnished K-1s from the Fund or the Administrator electronically if the Fund were to elect to do so (please initial we (and ontv one) category): The Undersigned consents to being furnished K-Is from the Fund or the Administrator electronically and not by mail. The Subscriber hereby acknowledges that it has read and understands the Disclosure Guidelines set forth below. The Subscriber must follow the Consent Procedures provided below for its consent to be effective The Undersigned does not consent to being furnished K- Is from the Fund or the Administrator electronically and wants to be furnished K-1s by mail. Disclosure Guidelines. By consenting to being furnished K-ls elecuonicalty as set forth above, K-1s will be furnished to the Subscriber electronically rather than by mail or any other means. If the Subscriber does not consent to being furnished K-ls electronically, the Fund and/or the Administrator will mail paper copies of the Subscribers K-1s to the Subscriber The above consent is for K-Is for calendar year 2013 and each year thereafter, unless and until the Subscriber withdraws such consent. Even of the Subscriber has consented to electronically recertsng K-1s as provided herein, the Subscriber may request a paper copy in writing. Request for a paper copy of a K-1 that has been furnished to the Subscriber electronically will not be considered a withdrawal of its consent. The Subscriber can withdraw its consent in writing or by omail to investorrelationsObamfunds.com. Withdrawal we be effective upon receipt and will be applicable to K-1s that would have been furnished electronically thereafter. If the Subscriber withdraws its consent, the Subscriber will receive future K-Is by mail. A withdrawal of consent does not apply to any K-1s that have previously been furnished electronically. The Fund will acknowledge receipt of any withdrawal of consent in writing or electronically, depending on how such withdrawal of consent is made. The General Partner may, in its discretion, decide not to electronically furnish K-Is to one or more Limited Partners, in which case paper copies of applicable K-1s to such Limited Partners will be mailed. If the Subscriber changes its information on where K-Is are to be furnished electronically, the Subscriber must notify the Fund and the Administrator in writing at the address or e-mail address noted in the above paragraph Similarly, the Fund will notify the Subscriber in writing or electronically if how the Fund and/or the Administrator will furnish K-1s electronically changes. To be furnished K-1s electronically, the Subscriber must have an e-mail address to which the fund and/or the Administrator can e-mail K-Is or notifications regarding K-1s. The Subscriber may be required to print a copy of its K-1 and attach it to its federal, state or local tax returns If the Subscriber consents to be furnished K-1s electronically. the Fund and/or the Administrator will send an e-mail to the Subscnber atter each year when its K-1 is available and the Fund and/or the Administrator will send an e-mail the Subscriber if any of its K-Is are amended. consent Procedure' To consent to being furnished K-Is by e-mail, the Subscriber must e-mail Investor Relations at investoselationsObamfunds.com stating that it wishes to be furnished K-ls by e-mail This will demonstrate that the Subscriber has the ability to receive K-Is by e-mail and will be able to receive K-Is sent to the Subscrber by e-mail in the future. Private and Confidential 12 CONFIDENTIAL UBSTERRAMAR00000635 EFTA00236334 K. Investor Signatures: Please sign below. Please note that signing below constitutes your signature to the Investor Application loin, the Subscription Agreement and the Fund Agreement in accordance with their terms. Spnature Date Athetteill Operate Signature le g. NM Newts. Date h 6 tame MO WC II NM Name Pent Name of Milesnal investor MAKE SURE YOU HAVE COMPLETED ALL APPLICABLE SECTIONS OF THIS INVESTOR APPLICATION FORM. Private and Confidential 13 CONFIDENTIAL UBSTERRAMAR00000636 EFTA00236335 For Financial Advisors All Investor Applications must be submitted on FIA to UBS Alternative Investments US no later than 5 full business days before 5 M. New York lime prior to month's end. I. Investor Suitability and NFA Bylaw 1101: With regard to the proposed investment of the aforementioned client in the Fund. I, as Financial Advisor to the client, by signing below, certify that I have: (1) informed the client of all pertinent facts relating to the liquidly and transferability of the Fund, including the obligation to maintain sufficient liquidity to meet ongoing capital calls (if the Fund has a capital call structure) on potentially short notice and that the investment may impact the clients future liquidity, (2) reasonable grounds to believe (on the basis of information obtaned f tom the client concerning the client's age. investment objectives, investment experience, income, net worth, financial situation and needs, other investments and any other information known by me, including the attached CAD that (a) the Fund being subscribed for is suitable and appropriate for the client; (b) the client meets all applicable minimum income, net worth, liquid assets and other objective suitability standards; (c) the client can reasonably benefit (including realizing any intended tax benefit, if applicable) from the Fund based on the client's financial position, overall investment objectives and portfolio structure; (d) the client can bear the economic risks of the investment in the Fund; (e) the client's goals are consistent with the time frame of the investment, and 0) the client appears to have an understanding of - (0 the fundamental risks of the Fund (including that the client may lose his or her entire investment); Cr) the restrictions on the liquidity and transferability of the Fund; WO the background and qualifications of the sponsoc(s) and investment managerls) of the Fund, and 00 the tax consequences with respect to an investment in the Fund. (3) obtained a valid and duly completed Form W-9 or W-8, as applicable, or successor form thereto, Signed under penalties of perjury by the client and I have properly placed such form on file pursuant to internal LAS Poky. and (4) confirmed, with reasonable due inquiry, including my review of relevant account documentation, the client's representations provided in the NFA Bylaw 1101 Certification (if applicable) Regarding Item 2(b) above, in the event that the client is an entity (such as a trust or partnership) that does not itself meet the minimum investment requirements (such as net worth) I have ascertained from the appropriate part es (such as the client's trustee or general partner) that all of the client's beneficial owners meet such requirements. Will this investment / gewIt in the client holding more than 30% of his net worth as evidenced on CAI in Alternative Investments? O YES B NO Initial If I assisted the client in completing any information that is required to be provided by the client in the Investor Application. I have done so pursuant to the client's authorization and direction solely based upon information that has been provided to me by the client. If I did not assist the client in completing any information in the Investor Application, I certify that I have reviewed the completed Investor Application Form, and I agree that all the information in connection with the clients investment in the Fund that is provided by the client is correct and accurate. II. Investor Qualification for Offshore Fund offerings only: I have reviewed the "Country Qualifications" appendix to the Memorandum or Subscription Agreement and in any applicable supplement to the Memorandum or set forth in the instructions on the UBS intranet, and I certify that I have reasonable grounds to believe that the client is qualified. under the law of its country of residence, as described therein, to invest in the Fund. In addition, it is critical that Financial Advisors review and understand the Rules of the Road ('ROTR'), with specific 10CuS on alternative investments, for each country in which the Financial Advisor expects to conduct cross border business and I hereby confirm that I have reviewed. understand and have complied with the applicable ROTR III. Financial Advisor Signature (Please Sign Below) Print Name of Financial Advisor 'N(.0ii• Stele V...ifiCtin Account Mt Financial Advisor Signature. Placement Fee. 0 % (2%. waivable in limited circumstances) (Fee will be charged in addition to Capital Contribution.) Date' (MUST BE COMPLETED) Note: If instructed, the CAI Statement that accompanies this form must be dated before or the same day this application is signed. Financial Advisors must reconcile the information listed on this application with the client's account records, including updating the client's net worth, objectives and any other relevant information. Branch CoderFA fr/Dmvon N101 ‘( I S t.:.) poi m Financial Advisor Telephone Financial Advisor E-mail Address mons, inttlit?supe your Branch Manager signs the following page. Surii • S-ta Cefricne ksbS • corn. Private and Confidential 14 CONFIDENTIAL UBSTERRAMAR00000637 EFTA00236336 For Branch Managers IV. Branch Manager Signature: I certify that I have reviewed the completed Investor Suitability and Investor Qualifications sections above, the dent Investor Application Form and CAI, and if applicable. the 'Country Qualifications" appendix to the Memorandum or the Subscription Agreement and any applicable supplement thereto or set forth in the instructions on the WS intranet. In addition, it is critical that Financial Advisors review and understand the Rules of the Road ("ROTR"), with specific focus on alternative investments, for each country in which the Financial Advisor expects to conduct cross border business. I agree. based upon the information known to me, with the Financial Advisor's determination that the investment being subscribed for is suitable and appropriate for the dent and the Financial Advisor has reviewed, understands and has complied with the applicable ROTR I agree that, if the Financial Advisor assisted the client in completing any information that is required to be provided by the client in the Investor Application, based upon information known to me, that the Financial Advisor has done so pursuant to the client's authorization and direction solely based upon information that has been provided to the Financial Advisor by the client. By signing below, if applicable, I have determined that (1) if the proposed investment is for an Access Person's (as defined in the Investment Adviser Code of Ethics) employee or employee-related account, my signature evidences my pre•approval of the trade and that (2) the Access Person's proposed investment: a) will not unfairly limit the ability of eligible clients of UBS Financial Services Inc. ('the Firm) to participate in the proposed investment and (b) does not present a material conflict with the interests of the Firm's clients or the Firm. Print Name of Branch Manager Branch Manager Signature. Date: (MUST BE COMPLETED) If the above named account is a UBS Financial Services IRA, then the Note: If instructed, the CAS Statement that accompanies this form Branch Manager, as a result, also signs as the custodian of the IRA must be dated before or the same day this application is signed. and accepts and agrees to this subscription. PLACEMENT FEE APPROVAL SECTION - THIS SECTION IS ONLY REQUIRED IF A REDUCED PLACEMENT FEE IS CHARGED To be completed by Complex Director or Complex Mmin Manager as Delegate (if necessary) By signing below you have agreed and accepted the reduced placement fee above in section In II you do not agree to the reduced placement fee, please inform the branch who is responsible for contacting Al Investor Service Call Al Investor Services at (888) 962-3842, option I, sub option 4 for questions. Pint Name of Complex Director. Complex Director Signature: Date (MUST BE COMPLETED) EF236556 Private and Confidential 15 CONFIDENTIAL UBSTERFtAMAR00000638 EFTA00236337 Subscription Agreement ADDITIONAL INVESTOR REPRESENTATIONS AND COVENANTS aCkrOVelethje, that III it has had tne opportunity to review the Funds Offering Memorandum ('Memorandum'; and to seek independent legal and tax advice in connection with rearing ths investment tii) neither the Fund. the Manager. UBSFS nor any of thee affiliates amities tax advice in connection with this investment, and (iii; the legal. tax and regulatory summaries included n the Memorandum are of an ndicatrve nature only. do not constitute legal, tax Or regulatory advice and may or may not be relevant to invetents personal cecurmtances. The Investment Manager (including its affiliates, as the case may be) entered into a placement agreement with UBS Finance' Services Inc. ('UBSFS- ; pursuant to when U8SFS win recent a substantial fee for distribution, account services, solicitation services a a cornbinat on thereof from the Investment Manager, which may constitute a majority of the management fee otherwise received by the Investment Manager from the Fund with respect to such clients Such fee wig be payable to UBSFS for as long as clients introduced to the Fund by UBSFS hold shares in the Fund or a successor thereto, or in a (Ltd managed by the Funds admen or a successor. UBSFS she receive account wry ring fees (and not dstribution fees) with respect to certain investors vial make this investment pursuant to an admen agreement To the extent perrisOble by apt:Scabs rules and regulations. 1)95 Financial Services, a placement agent la the Fund, may rebate all or a potion o' such fee to certain investors that make this investment pursuant to an advisory agreement weer, the Form or its Financial Advisors are compensate° for this investment Pursuant to such advisory agreement It the investment is covered by an agreement under a ties athisory program between UBS and the InveStOr. the Investor acknOwledgeS null the Investor cheeses to exit such UBS advisory program, the Investor may be charged the same Management Fee paid by those umited Partners of the Fund that are not subiect to a 1185 advisory program a redeemed out of the advisory share class and placed into a non-advisory share class, which may result in tax conwouerces and other penaltes The Invetta should consult with their Tax acute, on tbs and other matters before roaring an investment in the Fund Separately, the Investor acknoMedges that a Placement Fee of 2% of the apse contribution amount will be charged if the Investor invest through a brokerage account 140WeVer, in hrrvted circumstances the Placement Fee may be waned by the Placement Agent. This Placement Fee is n addition to. and will not reduce, the Investees Capital contreuton amount if the Placement Fee is reouced by agreement between the Placement Agent and the wrestor, then the reduced Placement Fee to whch the nvestor has agree° will be reflected on the UBS trade confirmation Investor understands and agrees that (it UBSFS and certan of its affiliates may be cempemated for referring UBSFS clients to abernethy investment vehicles managed by the Investment Manager or es affiliates other than the Fund. Oil such fees may be more or less than the fees received by UBSFS and m aft,liates in connection with the placement of interests in the Fund. ties generally, UBSFS and certan of its +Nudes are compensated for providing services to affiliated a proprietary altemathe irnestrnem vehicles, which compensation can include chuibution or referral Fees, investment advisory andror management and certain other fees, including performance fees, and as a result of the vanas payments to UBSFS and its affiliated COMpanies, The amount of compensation that UEISFS entities receive with respect to the sale of affiliated or proprietary vehicles 6 greater than the amount payable to the organization as a whole from the sale of unaffiliated treeestrents„,tiy) trar ifsirtids managed by third party lonerS, 0BSaS receives fees fa cliSetu7ion, shareholder Seven a Solicitation seances, Cr corribmation thereof, depending on the arrangement UBSFS has with the third party, (v) the payout the a Financia Adana receives may differ from one fund to another. even if the two funds ate charged the same nun/gement fee entity incentive.based fee tie.. even d. Overall, an Mesta would pay die sane amount in fees). arid (vi) the differences in canpensation may create an incentive for Financial Advisors to recommend funds for which they receive higher compensation investor nas contacted es frontal Advisor with any questions it may have regarding the compenSalon received by Investor's Financial Advisor Investor agrees to keep confidential any information (tatted to Investor by its U9SFS Financial Advisor relating to interests in the Fund Notwithstanding anything expressed or implied to the contrary heren, Investor understands tnat it is authorized to disclose to any and all pencra, without limitation of any kind, the tax treatment and tax st %Jaye of the transactions contemplated here., and all merest of any kind (induding %man or other tax analyses) that are provided felting to sucn tax treatment and tax structure investor agrees that at it discretion, the Fund or the investment Manager andfor the Administrator may (directly or through a service provider) provide to the investor (or the Investor's designated agents) statement, reports and Other COMMulli(atenS relating to the Fund endW' the Investor's investment in the Fund in electronic form, such as e-mail ander password protected account viewing pct the fund's web site, in lieu of or in addition to sending such cominuntatent as hard copes via fax or mad. Meade note that I1/241tia rressagn are not secure and may contain computer amuses a otter defects. may not be accurately replicated on otter systems, or may be ntercethed deleted or interfered with without the knowledge of the sender or the intended recpent The Fund, the nvestrnent Manager and the Aaiun/strata make no warranties in relation to these matters The Investor understands that the Fund, the investment Manager and the Acennistratta reserve :he right to intercePt. Morita and retain ems: messages to and from their systems as permitted by applicable law if tie Investor has arty doubts about the authenticity of an e-mail purponedy sent by the Fund, the investment Manager or the Adritristrator directly Cr througn a service provider), the investor is required to contact the purported sender enmediately The Investor acknoWedges that an sentiment in the Fund may have the effect of requiring the Investor to file income or other tax returns in jurisdictixis which the Fund or any underlying fund as deserted in the Memoranc/um) conducts investment activities. 'NEW ISSUES' EXEMPTIONS Not app cable to no victual retverntnt accounts. +rimer:al or JOIN accounts, uGmA or UTMA accounts that are treated as natural persons for INS purpose; lel The Beneficial Interest of restricted persons does not exceed in the aggregate 10% of the Investor or if the Beneficial interest of all restricted persons in the Investor exceeds n the aggregate 10% of the Investor but the Investor has implemented Madmen to reduce the Beneficial Interest of all restricted persons with respect to new issues in the aggregate below 10% lb: The Beneficial Interest of 5131 Covered Persons does not exceed in the aggregate 25% of the Undersigned or the Beneficial Interest of at 5131 Covered Persons in the Undersigned exceeds in the aggregate 25% of the Undersigned but the Undersigned has implemented procedures to reduce the Beneficial interest of al 5131 Covered Persons with respect to new issues in the aggregate below 25% 2. An investment company registered under the investment Company Act 3. A common trust fund that has investments from 1000 a more accounts and does not lime interest the fund pnropally to trust accounts of restricted persons 4 An insurance company general, separate or investment account provided that (a) the account is funded by premiums from 1000 or more policyholders or, if a general arrant. the insurance company has 1000 or more policy holders and the insurance comeany does not lent the policyholders wheat premiums are used to fund the account principally to restricted persons. or if a genera account the insurance company does not lime its policyholders principal), to resthicted persons 5 A huhlkIV traded entity ;Other than a broker-dear or an affiliate of a broker-dealer where such broker- dealer is authorized to engage in the public offering of new issues either as group member or underwriter) that is kited on a national securities exchange, is traded on the NASDAQ Nat oval Market. or is a foreign issuer whose weedier meet the quantitative designation Criteria for listing on a national secunbes exchange a the NASDAQ National Market 6. An investment company organized under the laws of a foreign junsdction provided that the imestment company is anted on a foreign exchange or authorized for sale to the public by a foreign regulatory aulhOrity and that no person owning 5 percent or more of the investment company is a restricted person 7. An ERISA benefits plan that is qualified under Section 4011a) of the Code, wowed that such than is not sponsored solely by a looker dealer B. A state or muriocial government benefits plan that 6 subject to state andaar municipal regulation 9 A taxnampt charitable organization under Section 501(cX3)of the Code 10 A church pan under Section 414(el of the Code Anti-Money Laundering Representations In ace( to comply with Vireo States and international laws armed at the prevention of money laundering and terior:st f lancing each investor that an inavidual represents that. among other things, Private and Confidential 16 CONFIDENTIAL UBSTERRAMAR00000639 EFTA00236338 he is not, nor a any person or entity cc:frill:ding, Controlled by or under common control w•tn the ✓vestor, a "Pfohibred Peron" la perSran involved in money laundering or terrorist activities, exuding those Pereens Or entilieS that are included on any relevant lists mantaine0 by the US Treasury Department's Office of Foreign Assets Control, any senior foreign poatical figures, their mime:kale family members and close associates, and any forergr stell bank: Further, each investor Mat is an entity represents that, among other thugs, it has caned out thorough due diligence to estaoksh the identities of is beneficial owners. lit it reatonaoly believes that no beneficial owner a a "Pronrbeed Person', fir: it holds tie evidence of such relent ties and status and wA maintain such inhumation for at least five years from the date of its complete withdrawal from the Fund, and (iv; It will make available such information and any additOnal information that the Fund anclice the Administrator may reca.ire upon request tat is reCithred under applicable regulations Each of the f una and the Administrator reserves tie rght to request such further nforniabon as considers necessary to verify the identity of a investor anday the source of fiords in the event of delay or failure by the investor 10 produce any information required for verification purposes, the fund andote the Administrator may refuse to accept (Cs process in the case of the Administrator; an application until proper information has been garbed and any 'wads received will be returned without interest to the account from whet the moneys were Originally debited US federal regulations and executive orders administered by the U S Treasury Cepanntra's Office of Foreign Assets Cory& l'CCAC": prohibit, among other Mtgs, the engagement in transactions with, and the provison Of services to, certain non.0 S countries, terntones. ambles and individuals The lists of CFAC prohibited countries. temtonn. persons and entities can be found on the CFAC web site at www teas gov/ofac Each investor represents and warrants that, among other things, rent of the nwstor. any pe•son controlling, controlled by or under co—mon control with the investor, any person Ninny a beneficial interest n tie investor or are, person for whom tee investor 6 acing as agent Or nominee in connection with its investment in the curd a a country, territory, person or entity named on en OFAC list or 6 a person or entity that resides or has a place of business in a country or tarty named on such list The Fund will not accept any investment from a prospective investor d it cannot make the representation described in the Preceding sentence n addition to OFAC restrictions, Investors and Limited Parners are required to prow* all information and dOCumentalical requested by the Fund, the General Parer a the Administrator to Comp), with U 5, anti- money laundering ,an and regulations as well as, P3skthr. comparable laws and regulations in other yurrsdichons Ths is an eroving area of the law. and the full extent of the disclosures winch may be required cannot to predicted By way of example, the Fund and the Administrator reserve the nght to request such information as is necessary to verify the identity of a investor and a source of funds. EF236556 Private and Confidential 17 CONFIDENTIAL UBSTERRAMAR00000640 EFTA00236339 Form IIII-9 ((Rev. August 2013) Department of the Treasury Internet Revenue Service Request for Taxpayer identification Number and Certification Give Form to the requester. Do not send to the IRS. if E E .2 - .t1 51 Name (as shown o your income tax rotten) Ghislaine Maxwell Business name/disregarded entity name, if different from above Check appropnate box for federal tax classification: 0 Individual/sole proprietor O C Corporation O 3Corporation O Partnership O O Limited lability company. Enter the tax classification (CwC Capita. Sw5 corporation. PapannersAp)S O °thee (see instructions)S Trust/estate ii Exemptions Exempt payee Exemption code (i any) Isee instructions): code p any/ from FATCA reporting Address (number. street. and apt. Or suite no ) 116 E 65th Street Requester's name and address (optional) City. suite, and zs, code New York , NY 10065 List account numbest') here ShOlionefi Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. II the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Social security number Employer Identification number Certification Under penalties of perjury, I certify that: I. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FNMA reporting is CbfreCt. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are Currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage ;ntereSt paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generary, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the structions on page 3. Signature of U.S. person Date th Tit General Instructions Section reterenceS we to the Internet Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS.gov for information about Form W-9. at onyw.4.gov/w9. Information about any future developments electing Form W-9 (such as legislation enacted after we release it) vii be posted on that page. Purpose of Form A person who is reared to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report. for example. income paid to you. payments made to you in settlement of payment card and third party network transactions, real estate transactions. mortgage interest you paid. acquisition Or abandonment of sewed property. cancellation of debt. or contributions you made to an IRA. Use Form W-9 only a you are a U.S. person (ncluding a resident alien), to provide yew correct TIN to the person requesting a (the requester) and, when appacable, to 1. Certify that the TIN you are giving is correct (or you are waiting for a numbs to be issued). 2. Cenify that you are not subject to backup wthholding, or 3. Claim exemption from backup withholding it you are a U.S. exams payee. If applicable. you are also °staying that as a U.S. person. your abrade share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of eltectively convected income. and 4. Certify that FATCA codels) entered on this loon (If any) indicating that you are exempt from the FATCA reporting. is correct. Note. It you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially svelte to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you we: • An individual who is a V.S. citizen a U.S. resident seen. • A pannershp. corporation. company, or association created or organized in the United States or under the laws of the United Slates. • An estate (other than a foreign estate). or • A domestic trust (as defined in Regulations SeCtion 301.7701.7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States we generally required to pay a withholding tax under section 1446 on any foreign partners' share of ettectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore. a you are a U.S. person that is a partner In a partnership conducting a trade or business in the United Stales, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partrier5114) income. Cal. No. 10231% Form W-9 (Rev.8-2013) CONFIDENTIAL UBSTERRAMAR00000641 EFTA00236340