EFTA00237366.pdf
PDF Source (No Download)
Extracted Text (OCR)
SUBS
UBS Financial Services Inc
Account Number
Client Qualification Form and Agreement For Options
Account Information
Should be completed by the Primary Tax Payer. Trustee or Executor
AM's/It fide
Ghislaine Maxwell
Ghislaine
Primary Account Holder f ast
Middle Name
Marital Status 5
Single
0
Married
0
Divorced
,.rf blank, km assumes single)
lowed
Maxwell
alt Name
argfi
ter of Dependents
ank, Firm assumes 0)
loot Account Holder First Name
Middle Name
last Name
Account Ownership (select one;
5
Sole Ownership
K
font Ownership
0
Trust
K
Estate
0
CuStOdan
Guardian/ComrnitteemaNConservator
K
BusaieSSOwnerstroP (specify type)
Type of Trading Authority (select one. it applicable)
0
Power of Attorney
home Cellos Desteetor.
— VA Ehscretionary :includes PMP)
0
FA Name
Return 04SL-lives/Risk Tolerance
1. Risk Tolerance: Which of the following best characterizes your tolerance for risk in this account?
O tow Rig
K
some Risk
E
Moderate Risk
E
Moderately High Risk
S
High Risk
2. Mularteent Objectives: What is your pwnary investment objective for this account/
L
Produce current income (Not valid for Moderately High Risk or High Risk)
• produce a combination of income and capital appreciation
E Achieve capital appreciation (emphasis on growth of capita), not income)
3. Risk Return Objectives: Which of the following best characterizes your irsk/return obi/chi/psi
C lam Winn/ interested in maintaining my invested capital. and I AM not prepared to accept higher fluctuations in the value of my assets
(Not Vend to Moderate, Moderately High Risk Of High Risk)
•
prefer to sustain only moderate fluctuations in the value of my assets to achieve moderate returns
•
In order to achieve a hgher return, I am prepared to accept higher fluctuations in the value of Masse% (Not valid for low
Risk or Moderate Risk)
4. Investment Time Frame: What is your average *muted lime horizon lot the investments in this account?
D. Less i
3 years'
LI 310 6 years (an average market cycle)
5
T to 10 years
O Longer than 10 years (through several market cycles)
5. Short Term Liquidity Needs: Do you anticipate a need for cash in the ShOrt term from the assets in this account)
K
yes. S
No
8. Investment Eligibility Consideration: in accounts with conservative Cr moderate risk profiles, investment elicability consaderatoits
identify whether you may be etigibee to invest in certain higher rink securities as a portion of your portfolio. These investment
additional diversification .rid may induct. complex strategies, limited liquidity and greater volatrity
agree twat a potion of my portfolio may include investments with complex strategies, kmited liquidity and greater volatility
I23 Yes
Ow
p us
otter
• ley you hare in0Caled Morkvately Hgn Mg or High Risk as your Risk Tolerance. acneying your inyeSinsenf goal' may be less likely with
shorter ttme nouns% or it ssiu anticipate needing to withdraw cash ItOM end account in the next 72 ri ow In
AC-OPT (Rev 09/14)
I
0 59954869
11
Pape 1/S
O2014 U8S financui Services inc All right 'ewe to Merntsei
CONFIDENTIAL
UBSTERRAMAR00001733
EFTA00237366
Financial Information
for a Trust, Estate or Business account, financials should be listed under Primary Account lipkaer section
it you store with another person, Orease prowat thy for owing financial information. per incirindrarri fa ioampe, a total net worth Of S
should be split as you deem appropriate an equal 100% of the combined assets
Prirnary Account Holder
Joint Account Holder
Total
Annual Income
broad Assets
(defined as cash and marketable secuntieS)
Net Worth
(Exclusive of Residence)
$250,000
520,000,000
$30,000,O00
$
$ 250,000
$20,000,000
.000
s30,000,000
Investment Experience and Employment Infatuation (Primary Account Holder)
For a Trust. Estate or Business account. please Mt out the information for the oxlmdual responsible for the account fe g matte fore trust
account}
o left blank, Film assumes 0
Number of years investing experience vath
20 Equities 20 Bonds 5
Futures 10 Options-Buy 10 Clowns-Sell
Which best describes your knowledge of investments'
I know very mule about financial markets and market investments
r-- I have a good understandskg of financial markets and market investments
•
am an experienced investor in financial markets and market investments,
Employment Status (select one)
K
unemployed
0
Retired
J SelhEmployed E Student E Work in the Home
2) Employed ixovide occupation and employer below
Founder President
The TerraMar Project
Occupation
Employer
Irwestrnent Experience end Employment Inlammion (Joint Account Holder)
Numb., or years investing experience with
Equities
Bonds
Futures
Options-Buy
Options-Sell
_
_
_._.
Which oest oescribes al knowledge of investments, 0
I know wry little about financial markets and market investments
O
I have a good understanding of financial markets and market investments
O
I am an exPenenCed investor in financial markets and market investmentS
Employment Mahn (select one)
O Unemployed Li Retried
O
Self•Employed
K
Student
0
Work in the Home
O
Employed provide occaion and employer below
Occupation
rmi; nye,
Trading Options
Anticipated
Manager
Anticipated
Manager
Option Transaction
Trading
Approved
QfalbahlalettlEM
Trading
Approved
Covered Noting
>I
iii
Interest Rate Corons
LI
Buy Hedged Puts
5
0
Foreign Currency Options
0
0
viola Options
5
0
Uncovered Options (Calls/Puts)
5
0
Huy a Covered Writing (Spreads S. 5
0
Cash Only
E]
0
Purchasing Options)
Set Secured Puts (1.841 Secured
X
0
in Cash Account OnM
AC-OPT (Rev 09/14)
("5"691
Flagg/
II
02014 LAS Financial Services Inc All ugh reserved Member SSC
/ I
CONFIDENTIAL
UBSTERRAMAR00001734
EFTA00237367
SUBS
Options Agreement
introduction
Throughout this Agreement, 'you'. 'your' and 'yours' refer to you as Client(s) of UBS and to each person who signs 016 A9f
'UBS'.
'LW, 'our and -ours' refer to UBS financial Services Inc and unless we indicate otherwise, its successor firms,
Tones,
correspondents and/or affiliates or employees, including without limitation its parent company U85 AG and its affiliates UBS Financial
es
Incorporated of Puerto Rico (which clears through UBS Financial Services Inc ). UBS Bank USA. UtiSS Credit Corp . UBS 'OW Company. N
and
their insurance agency affiliates and subsidiaries and all other subsidiaries and affiliates
Mw-mint Representations
1. By signing the Client Qualification Form and Agreement for Options (*Agreement': you acknowledge and agree that
a UBS does not provide legal or tax advice
b You have received a copy of. and you have read and understand, the current version of the Characteristics and Risks of Stand dized
Options booklet (•Drsclosure Booklet') with all applicable amendments. which explains the duties, responsibilities, and risks associated
with options trading, and that you must comply with at applicable duties and responsibilities set forth in such booklet
YOUI Financial Advisor has explained the mks of option trading and has advised you, in light of your financial condition and in
tment
goals, to carefully comedy whether options trading is hatable for you You understand that this brief statement cannot c
r all
elements of risk and other significant aspects of trading in options, and that it vi be incumbent upon you to carefully c
all
options trades made in your account
d You (i) have read, understand and agree to be bound try the terms and conditions set forth n the Agreement and all other
.is
included therewith or otherwise completed in connection with opening the account; 00 are certifying that the information pi
d
the Client Qualification Form is true and accurate, and (iii) agree to immediately notify Lif35 in writing of any changes to any or al l the
information contained in the Client Qualification Form or any other documentation provided in connection with the °prim
the
account, irolucksg, but not limited to those regarding your financial situation or investment obit.< tins
e You understand that options may be speculative and that you may sustain a total loss of the funds deposited with 1 OS W
buy or sell options, or to establish or maintain a position in the options market You understand that placing contngencyprdets
will not necessarily limit losses to intended amouts. woe market conditions may make it impossible to execute such orders
I
ties is authorized to rely on this statement in order to assure itself that you fully understand the risks associated with trading opti
Rules and Regulations
2. You are aware of and agree to be bound by the constitution, rules, regulations. bydaws, interpretations, customs, and usages
the
Options Clearing Corporation ('OCC'). the Financial Industry Regulatory Authority f'FINRA•), the cerium exchanges a mrk
and
clearing facilities. it any, where the transactions are executed, and all governmental statutes, Mei and regulations, including thoselof the
Senoiton. and Exchange Commission, as currently in effect or as they may be amended, resnsed cii supplemented Further, you are aware
of and agree to comply with the applicable rules and regulations with regard to options trading in your home country or the
equivalent.
3. coo hooter „sore Mat you wit not, (stint; atone or 411 conceit with omen,. .route the position so exercise .,inns. which the tniilarpel.
markets a clearing facilities may set from time to time You expressly authorize UBS, in its sole discretion, to touidate or close out :any of
your option positions without notice to you and without your prior consent, if and when your open positions exceed applicable
tiOn
snots to reduce such open positions to comply with such limits You will be held solely responsible for any tosses associated with
h a
reduction or liquidation
4. YOu vnil not write any option on securities of an issuer of which you are an of fatale within the meaning of Rule 144 under the Setun
Act
of 1933 at the time of such writing, unless the securities can be sold without restriction
5. You understand and agree that in the case of assignment of option contracts. UBS will employ the random method of allocation. In this
procedure, UBS will randomly select Dom all customers' short option positions, including positions established on the day of assighment.
those contracts which are subject to exercise A detailed description of the method is available upon written request You understaed that
American style short option positions ale 'able for assignment al any lime, white European style short options can only be assidned at
expiation
i
Terns and Conditions
& On certain trading days. trading may cease or be restricted in one or more classes of options and this may (twit in financial disadvan4ge or
loss to you. 'a agree to hold UBS, its officers, directors, and agents, harmless for this or any other loss resulting from any acts n4de in
accordance with the constitution, lutes, interpretations arid policies. customs, or regulations of the exchanges involved or the OCC
7. You acknowledge and understand that (i) any orders given by you or through anyone else to buy, sell or exercise options in your account
may be refused by 085 in its sole discretion, (ii) we may restrict ca• prohibit oaring of securities or other property in the e - unt. (m; We may
or CanCel any accommodation or credit extended to you by us. and irv'i we may close the account at any I
You agree to
l f
indemnify and hold us harmless from and against any losses, causes of action, damages and expenses amino from, a
s a resuit of our
taking any of these actions
8. You understand that UBS has established 4.30 pm Eastern time on the Enday of or before the expiration date of your option contract as
the cutoff time for accepting en exercise notice fran you This cut-off tate may differ from the times estattrshed by the applicable
exchanges and the OCC You are solely responsible for taking necessary action to exercise an option onv a within the time frames Lies
has established further, you are solely responsible for confirming that all exercise notices and related instruc tons provided to ties are
accurate and complete. UBS will not be tub* for your failure to tender an Macrae a if we do no: *cc-, :2 GIPce of vat:, tendel heron the
established cut-off time
ACOPI (Rev 09/14)
0159954869'
02014 UBS Financial Services Inc All right eSeiven Mernoer S
CONFIDENTIAL
UBSTERRAMAR00001735
EFTA00237368
*UBS
9. You understand that kW options that are SO 01 or more "in-the-money' at expiration are suteecl to automatic exercise, and
be
exercised automatically unless 1)85 reserves instructions to the contrary You explicitly waive al: claims for damage or loss i1 you fail to notify
us to exercise an 'in-Ilse-money' option that is Da subsea to automatic exercise
10. If you faa to make payment of any monies due to UBS for any transactions covered by this Agreement, you agree that we may
any
property ha in any of your accounts and apply the proceeds of such sale on account of this indebtedness
11. If you fail to make dekvery of any securititS due to UBS for any transactions covered by this Agreement. you agree that we may buy4 such
pitzetion in your account and apply the cost of such purchase to you on account of this indebtedness
12. Any and all expenses incurred by us in connection with ether of these transactions may be chalid to your account(s). and you a¢et to
fully reimburse us for any such expenses
13. n case of any insolvency. bankruptcy, death or attachment of your property, you agree that we may take such steps as we c
necessary to protect UBS against loss with respect lo any penoing options orders or positions
14. This Agreement supplements the Client Refati
eement (including any predecessor account egfeementi, which is inc0rpOrated
bowl by ielerence In the event mat any specific =son of this Agreement conflicts with any provision of the Client Relationship
Agreement or any other agreement between you and L/F4S, this Agreement shah control, except that nothing in this Agreement will diminish
any of UBS' rights under the Client Relationship Agreement or any other agreement between you and UBS
15. This Agreement may be assigned by 1)85 and will inure to the benefit of U85 's successors or assigns and shall be lading on you and your
Personal representatwes
Power of A
16. if you have
that a Power of Attorney has Trading Authority on your account. you represent and warrant that you have provided
authorization tor one or more Agents to conduct options transactions ORS may continue to relay on the Power of Attorney. absent aHrept
o' written notice of its revocation
Special Statement for Uncovered Options
17. If you have indicated intent to engage in uncovered options transactions, you understand. allnowledge and agree that
there are Special risks Soiled with uncovered option wilting which expose the investor to potentially pond Kant loss, Therefore, 114 type
of strategy may not be suitable for ell customers aporond for options transactions
f
II
a The potential loss of uncovered call wasting is unlimited The miter of an uncovered can is in an extremely rrsky position.. rna4 inc .
large losses it the value of the underlying nal oaten! increases above the exercise prte
b. As with writing uncovered calls, the risk of writing uncovered put options is substantial The writer of an uncovered put option bears a
risk of loss if the value of the underlying instrument declines below exercise price Such loss could be substantial if there rS a sigrflicant
decline in the value of the underlying instrument
:
C Uncovered option editing is a
only for the knowledgeable investor who understands the asks, has the financial cepa(
and
e g
willingness to°Cur potentially substantial losses, and has SultiCient liquid assets to meet applicable margin requirements in this r
aid,
it the value of the underlying instruments moves against an uncovered !I'S
options position. the investor's Financial Advisdi may
request significant additional margin tents
1 an investor does not make such margin payments. the Finance/ Advisor may liquidate
stock or options positions in the investor account, with kale or no pror notice in accordance with the investor's margin agreement
In. Combination writing. whew the investor writes both a put and a cal on the same underlying instrument, the potential no its
Date on which Disclosure Booklet was provided: 01/22/2016
Primary Account Holder:
Ghislaine
Maxwell
First Name
Last Name
Dale
bwat Account Hader
First Name
AC-OPT (Rev 09/14)
y. tit
/Lily
Last Name
Date
01599548691 Oa
O2014 USS Financial Services Inc All nigh
ever Co Member ..'At.
Page 415
CONFIDENTIAL
UBSTERRAMAR00001736
EFTA00237369
UBS
Financial Advisor;
first Name
tag Name
Designated Registered Options Principal:
Signature
Date
First fl
Last Name
Signature
Date
Designated Sunnis=
No Name
test Neer*
Signature
Dale
01599548O i
AC OPT ;rstev. 09/14)
O2014 L)95 financial Services Inc All ogn•
esc-Heo men
SFPC
CONFIDENTIAL
UBSTERRAMAR00001737
EFTA00237370
Revised 2/12
* UBS
Alternative lnvestments US - Additional Subscription Form
ALPHAKEYS M1LLENNIUM FUND LIÆ
Please retum thls form to
your Financial Advisor
slo
DA e
The uletiefligrted hardy wiihes to contribut• additionst cepvai to the above.named fund (the 'Fund")
c:ease rndstate ansOunt of addibonal taptal ccestiibulion ln USS
The undersigned confirms that the amount contributed d cormstent with the Furs ds m.nenum "titanet .mestmen requeements
The unde .gned atknowtedgm (i) that the understgned rs mating an addibonal capita' conthbutson on the terms and tonditions conta:ried cl the Contidential
Memorandum of the Fund premously rece:ved by the undersgned, the governing documents ot the Fund as currentty in elt ect and the Subscription Agmement or
Investor Applgatiort pesiously executed by the undersegned and accepted by the Fund (the 'Investor Application-). and (ri) that the repesentabons and warranties Of
the undesrgrted contained in the Investor ~Kalien se true and con.« in all respects as of the date set forth betchv In addition, the underst,necl acknowledges
;hat a placement fet of 2% of the <epital contritution vall be charged d the undesigned invests through a broketage accouni. However. in limited circumstances fete
OlaCement fee may be waived by UBS Financial Seneces Inc , as placernent agent Ths plee ~tnt lee is in addition lo. and unt not reduce, the undersigned's capita;
contritmtion
THE UNDERSIGNED AGREES TO NOTIFY THE FUND PROMPTlY SNOULD DIER( BE ANY (MANGE IN ANY OF THE FOREGOING INFORMATION.
The trivest& hereby autnocues the debil of lunds lot the <apte romnbution. pus any ego: eat» par ement lee, and any applicable amount regelved to satsrya tak
obttgation of the fund
By signing below the underogned acknowledges, repments and agrees that: (a) it has carefully read and is Familier with the Investor Application and
the Runes goverreng documonts (collectively. the "Agreements'), including the predispute arbitration clause which appears in the Agreements and
(b) it hereby confirms that ~lb respect to the information maintained by U8S Financial Services Inc. regarding the understgneds portfolio held at UBS
Financial Services Inc, the investment objective and risk profile applicable to the investment in this Fund are respectively, "cal:Atal appreciation' and
"aggressive" and that this objective and risk profile is applicable only to Ibis investment and may diller from the investment Boals and risk tolerance
for the overall ponfoilo and the bsokeeage account in which thls investment n held.
tent &gnatt/en (Pta,* sur Dekret?:
(nh;slai ne
Ra .,Met‘
I
Pri4(
N*** menes 3.grathre
g vin: wne*
oase
Ret Alle ei ****.e..nry.
For Anancial Advison and &an& Mannen
1.
Investor Sultabikty and HVA bylaw 1101;
Wfth ?Kjeia to t-e• pecooted inn-timene of the etatene-tina drit st the Fund. L ålf ~us Sa!~ :c ;na Megt by trineng bak*. certfY
l hem
id demra toe otten, ol att portvin !Ku rereng to Me Aveny and transterabety d the Fund. "kiling the obl9pon to mente., sanitet ~db to ~enga%
tapal rast li' ne FL*, rasa 444414 ull munn; or. patentally "hon notice and tite Ne envemmeni møy *pai Nec en:, tururo **Orts.
2.
vestenabe geOarat to belen ton the onne informatin cand from the cent cancering the chic sage. elveStment ~ties, imitere° acierirce. ncome. net
crorth, franul ot,..at On and nied. adr ~rytmernb amt am 00W information kn** by n. nosi"' de stueed Cm eiet
(at
the hoc bang kasscubt4 to, 6 screatie ard 1.19rocnate lor me Pent.
[te
~Pent mett all appfeetbeilinrenf.en raene, net Warth. ~d essets ard omet *edrue* setwil ty standards.
te)
are drent <an :Kommady
I
ing mak** all riandlid tea benda. kabl
kaun Ne f‘indbased mthe arent's fenamas! coda,,,tea0
ry*Sterent ~Wen anggon.0.1
LO))
be dont can uld tnt «On** reis d the "'strev" cf, the Fure.
tel
the deres gods se cormstem with tert bene kame af tre ~entMent, and
(0
the deni apcnn W lyne an undentardirg al
IN findammtal riks or the Fund lakene trut tri
may kne rm or mr ~e "Mimen..
(r)
the maritim an lei artsled and vansterabicy al Se Fise.
le:
the tukkgain0 and thialificato-o d the sprotet; and investment mangen.. (dine f Lei ca. Jåla
I sd
ale tad OXISINIVenCes, ***Wc! to an ritiewibm n the hund,
(3)
aurane a rakl and durylOrnpfeted :.Cen, W9 Of W.8. ry *Pal*. or tamme form term. 'gned urder ***Id
permy ty tnt ment and i hevt Ot
~ed
tren form on toe pnarn lo internat IdttS ØKy. de
contrmed, isdn reasciable due nowy, irktuding my fl** of relevant &trøytt cocumenution. the :hr (teori momsen:mors dmindeci n tnt NSA %hm 101
Centicaton (d apricamt.
Reglfedfeg enn 2..b1 Ø.
in Ilse *Vent that Me <kant n an enhy Ifull asa :rustar ainerthp) Mat (10ry rot .he,f rytt
mry*.fm einanen eg...rimen% ;Sud.* ret
warth. I nave elertened hem the approehate partes d...en as the (ems Dustet er general partntr mat ali of the Oie«. ~mei earl,, meitt 55;h requiemenet
wa
~omn result re, the mynt nolo"; mye Man 30% of hn net ~ren x esamed on CA. n **mal« Instiments
O yte Ei NO
By menig brette' underhened FA en ce.s6V.s Mat the underPgned knOwt deect.fe of hel o her tvm knowledge tMl lebt $ LØY* gOsenrg do(umentl man taletWevaine
oelperted to the memo,
kwestor Otialifieation for ("ore Nr* ofteringa orer
i han mane* the 'County QualreatiOnC ~elda to the MOMOraridarn of S-Ourrpta, Aveemerd and ei alv *opium supplement to tre MeenCandym Ce* let sym in the
riStr..fati S on Me LOS stat. and mendy the hese vareabe grovdl b be** tat Me <lent ns quaded. cexler Se Nor d OS 0)...nty d inri:lena. as Ordren etrem. to
mint n tnt fund h adelen, it is~
tal Finn.' A*60,5 meny and ~urd
tre Rutet or ~Rom r'ROTR' i. ente 'mol< forta on alunane ers*Irntesta. Ce aen
COuntly ei Øde
Fnattete Arknor meis to concixt <rors border basmels end I netly centner MEI** tnt**. tryekeStand ante hase complia sin tre appatabt ROTR
CONFIDENTIAL
UBSTERRAMAR00001738
EFTA00237371
Fonn
W
-
9
(Rev. Decants 2014)
Depanment of the Treasury
Warne Peeve Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
CL t
Marne (ace Uown on your noon. tax return). Name n reputed on the Ana do not Were the brie bank-
GhiSlaifte Maxwell
2 Business nameroaregarred entry name, a entwine Porn 'beet
3 Crock approcnale bOx to 1001.11 tax deashosom chick only cee of be tolitneng eni
boxer
otndNwuavaoleprobnetaa
❑C
COMOIlinn
0
Cafferabon OPauwWp
0
friatestate
singe-member LLC
K
Umced liabdity company. Enter eta tax claselacation
porpealron.S4 corponeon, Pepanneneepje
Note. For • inglemember LLC that al denegardsd, do not dun LLC. cheat the aPINCOnele boa n the line abrree Ipr
the tax claudication of the einglementierOwn
()ow Negmtructono•
5 Address hunter. strut. an:144ot as no.)
4 Fri-notions ;codes apply ore to
certain Wane not "inviduals, see
ineauchins on page 3)-
Exempt Payee code (It any)
Exenoton Fort FATCA reporting
code (if any)
tAsos. &ocean mans*, mos re OS
state, and DP code
NODS is name and addrese lontonaft
7 Liu account number° here (044KmaA
Taxpayer Identification Number (TIN)
Enter your TIN in the appropnate box. The TIN provided must match the name given on tea lt* avoid
backup withholding. For individuals. this is generally your social security number (SSM. However, for a
resident alien, sole proprietor. or disregarded entity, see the Pan I instructions on page 3. For other
enbtea, it is your employer identification number (E2). if you 00 rid have a number. see How to get a
TIN on page 3.
Note. II the amounted", more than one name, see the instructions for line I and the chart on page 4 for
guidelines on whose number to enter.
I aisalei artemall number
or
17.4144/kietbriessinber
1
Part II
Under penalties of perjury, I catty that:
1. The number shown on this tam is my correct taxpayer denttlication number (or I am waiting to a number to be Issued to mei; and
2_ I ant not Subteet to backup withholding because: (a) 1 am exempt from backup withholding, or (b) I have not been notified Dy trio Internal Revenue
Service (IRS) that I am subject to backup *intoning
as a °sub of a failure to report at interest or dividends, or (c) the IRS nelt notified me Mall am
no longer subject to backup withholding; and
3. I am a V.S. citizen or other U.S. person (defined below); and
4. The FATCA MOUS) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct
CartIRCElon Instruction*. You must cross out itern 2 above if yOu have been notified by the IRS mat you are currently subject to backup withholding
because yOu have faded to report au interest and dividends On 2PUr tax return rot real estate transactions. darn 2 does not apply. For monger
.flmutest Paid. acquisition or abandonment of secured property. cancellatton of debt. contnttutons to an indMdual retirement arratIgireal (IRA). and
gonerady. payments other than interest and diddratidS. you we not requited to sign the CeddealiOn, but you must provide your correct TIN. Sea tee
struc: ons on page 3
Certification
General Instru
Section releninces ere to the Internal Revenue Code unless Oflrevie• noted
Future o.r000rosols. mammon about demiopments attend.; Preen W-9 (such
as lualaton enacted alter we release Ms at Went WS govaw9
Purpose of Form
an individual a entry (Form W4 requester) rano is require! to Ale an intormaeon
ration wen the IRS must obtain your correct lakpaye CerthaCetiOn Niter ay*
which ney be your pun tacudy number ISSN) rowidual taxpayer clerelicatich
number ITP0 ado(
to pays' identhcatfon number !kW. or *TOWN
clentecation peter (224). to report on an wont: ion return the amount pie to
you. or Other ran
reportable on an tniconaice return Examples of intOrrnenon
returns 'Meade. WI we MN tented to. the toilariecr
• Form 1099-PIT (rntennt earned or Pei)
• Form 1099.CW Idaidends. irCludisa Mese from stocks or mulusi !impel
• Form 1099-MISC (vwcus types of income, pntes. awwas. Cr cross proceeds)
• Form t099-13 (stock or mutual fund sates and certain Why InuneCIIOne by
broken)
• Form 1099-S precedes iron real estate transactions)
• Form 1099-K (merchant cad and owe pang network IrereadINNI
Date •
/n2flee
• Form 1098 (home mortgage neat
1096E piludein loan merest), 1095.T
(town)
• Farm 109$-C berated obi)
• Form 1099-alacquisaton or abandonment ol secured property)
Use Form W-9 only a you we a U.S. person Anducto; a resident alien). to
MINN y040 COrrOV TIV,
ff you do not main Fenn W-9 to fal requester wet • DN. YOU rart be subeld
anCUp wrinnorchnd See Whetas backup wartolang? ob i owe 2
By Oran the Nled•out form, you
1. Cerny INN MI TIN you are pivng 4 cared Or you we watt.; for a number
to be eaued).
2. Coley Nit you re not subject to NOCku0 entrecaIlma. or
3 Clam esernpeon from backup with vah ig a you we • U.S. exempt payee. It
ansineble, you ate also cartifying Mit as a U.S. nelson. yOur ellOCable son of
any ParMarsho Mooed tom a U.S trade or tundra is not Sent
OD the
withhold's; tax on lough partners' Val of ellectrvety connected event and
4 Certify the FATCA cone) enured on the form (d and indoatto OW you are
erect horn Ihe FATCA reporting. is correct See What 4 FNMA repordng7 on
page 2 for haver nformat•on
CaL ell. 10231X
Fortin W-9 (Per. 12-2014)
CONFIDENTIAL
UBSTERRAMAR00001739
EFTA00237372
Document Preview
PDF source document
This document was extracted from a PDF. No image preview is available. The OCR text is shown on the left.
This document was extracted from a PDF. No image preview is available. The OCR text is shown on the left.
Document Details
| Filename | EFTA00237366.pdf |
| File Size | 1433.8 KB |
| OCR Confidence | 85.0% |
| Has Readable Text | Yes |
| Text Length | 28,716 characters |
| Indexed | 2026-02-11T11:55:26.164801 |