EFTA00237811.pdf

UBS whAr4ement Revised 2/12 S I ts Alternative Investments US - Additional Subscription Form ALPHAKEYS MILLENNIUM FUND LLC Please return this form to your Financial Advisor The undersigned hereby wishes to contribute additional capital to the above-named fund (the "Fund"). Please indicate amount of additional capital contribution in USS The undersigned confirms that the amount contributed is consistent with the Fund's minimum additional investment requirements The undersigned acknowledges (i) that the undersigned is making an additional capital contribution on the terms and conditions contained in the Confidential Memorandum of the Fund previously received by the undersigned, the governing documents of the Fund as currently in effect and the Subscription Agreement or Investor Application previously executed by the undersigned and accepted by the Fund (the investor Application and (ii) that the representations and warranties of the undersigned contained in the Investor Application are true and correct in all respects as of the date set forth below. In addition, 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 UBS Financial Services Inc., as placement agent. This placement fee is in addition to, and will not reduce, the undersigned's capital contribution THE UNDERSIGNED AGREES TO NOTIFY THE FUND PROMPTLY SHOULD THERE BE ANY CHANGE IN ANY OF THE FOREGOING INFORMATION. The Investor hereby authorizes the debit of funds for the capital connibution, plus any applicable placement fee, and any applicable amount required to satisfy a lax obligation of the Fund. By signing below the undersigned acknowledges, represents and agrees that: (a) it has carefully read and is familiar with the Investor Application and the Fund's governing documents (collectively, the "Agreements"), including the pre-dispute arbitration clause which appears in the Agreements and (b) it hereby confirms that with respect to the information maintained by UBS Financial Services Inc. regarding the undersigned's portfolio held at UBS Financial Services Inc., the investment objective and risk profile applicable to the investment in this Fund are respectively, "capital appreciation" and "aggressive" and that 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. Client Signatures (Please sign below): gong 0ew adsranal Pivot). Pratte* beg pa: twunto Dare his IriatP Ma twe er It Na... Pere wareof addiaons imntor For Financial Advisors and Branch Managers kwestor Suitability and WA Bylaw 1101: Win regard to the proposed investment of tne aforementioned client in tne Fund, r, as Financial Advisor tote client, by signing below, certify that I have (1) rifained the dent of el pertinent fx:s relating to the liquidly and MinSlerability ol the Fund, including the obligation to mantan suff oent lqudity to meet ongoing capital calls tit the Fund has a date call souove: on mentally short rata and that the investment may impact the client's tuba liquidity; (2) reasonable grounds to believe (on the oasis of "formation obtained from one client concerning the client's age, investment opectives, investment experience, more, net math, 'manna' utuat cri and neeos, other investments and any other information known by me, including the anacheo CAl) that (a) the Fund being subsated for is sortable and appropnate for the dent, (b) the client meets all applicable m rumum income, net worts, Load assets and Other obfranre suitability stamens. (c) the client can reasonably benefit (including reeking any intended tax benefit, rl applicable: from the Fund based on the client's financial position, overall irwestrrent Mecnves and portfolio structure, (d) the client can bear the eccnornsc risks of pie investment in the Red. (t) the client's goats are consistent with the urns frame of the niestment. and ff) the dent appears to have an understanding of: (I) the fundamental risks of re fund (nclading that the them may lose his a her ent re resenment), Iii) the restnclicns on the I quioty and transferability of the Fund, liii) the background ono qualifications of the sponsor.* and investment managerts) of the Fund. and (iv) the tax consequences with respect to an investment in the Fund, (3) obtained a vai d and duly completed Form W-9 or W-8, as appcatie, a successor form thereto, signed under penalties of perjury by the client and I have properly placed such lam on file pursu✓nt to internal UBS policy, and (4) confirmed. with reasonable der inquiry, including my renew of relevant account documenution, that the dent's representatons provided in the WA Bylaw 1101 Certification Of amicable] Regarding Item 2(b; above, in the event that the dent is an entity such as a trust or Mlnostip) that does rot bell meet the minimum nvestmtnt requirements (such as net worth) I have ascertained from the appropriate panes (such as the client's trustee a general partner) that al or the client's beneficial owners meet such requirements Will this investment result in the net holding more than 30% of his net wash as evidenced on CAI in Alternative Investments' El Yes OM By sarong below, the undersigned FA acknowledges that the i..niersigned knows dewy of he or her own knowledge that the Funds governing documents have been previously °Overt., to the investor 11. Investor Qualification for Offshore Fund of f wimp only: I have reviewed the 'Country Cuarifications' appendix to the Memorandum or Subscnption Agreement and in any applicable suppement to the Memorandum a set forth in me instructions on the UBS 'curare, and I eerily that i have reasonable grounds to believe that the dent is qualified, under the taw of its country of residence, as described therein, to invest in the Fund. In addition, it is cntical that Foanbal Advisors review and understand the Rules of the Road (' ROTE), with specific focus on alternative investments, for each mangy in which the Francial Advisor expects to conduct cross bonier buttress and I hereby condom that I have reviewed, understand ad have complied with the applicable ROTR. CONFIDENTIAL UBSTERRAMAR00002251 EFTA00237811 Fenn lAlf-9 (Rev. December 2010) Department of the Treaty Infernal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. I Name (as shown on your inbeilie tax return). Name is required on this line: do not eaie tr.s 1, rK Plank Ghislaine Maxwell 2 Business namerdere9wdad entity ma if s wat 'roe' move 3 Check appropriate box for federal tax ciasslfication theck only one of the following seven boxes a Indmdual/sole proprietor or 0 C Corporation 0 S Corporation 0 Parlrership single.rnornber LLC 0 united liability oolTPatlY. Enter the tax classification (C-C corporation. S.S corporation. P•partriershim Note. For a single-member LLC that is disregarded, do not check LLC: check the apart:coat, box in the tax unstficatica of the single-member owner. 0 Other (see instructions). SI TruSi/eState . 4 Exemptions entities. cinsertain tructions Exempt payee Exemption code Of any) wow, r• ixiiv.ni (codes apply only to not individuals: See on page 3): code (II spy) from FATCA reporting the tine above for sneer ousts re Lee) 5 Address (number. street, and apt. or suite no) Requester's name and address (OPtiona9 6 City. state, and ZIP code New York, NY 10065 7 Ust account nurntens) here (options) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropnate box. The TIN provided must match the name given on line 1 to avoid I Social "Cork' number backup withholding. For individuals. this is generally 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 Mon page 3. Note. If the account is in more than one name. see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. NNW Or Employer identification number iai Certification Under penalties of perjury, I certify that: 1. 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. l 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 FATCA reporting is correct. 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 interest paid, acquisition or abandonment of secured property, cancetiation of debt, contributions to an individual retirement arrangement ERA). and generally, payments other than interest and dividends. you are not required to sign the certification, but you must provide your correct TIN. See the instructons On page 3. Date ► General Instructions Sect vices are to the Internal Revenue Code unless otherwise noted. Future developments. information about developments affecting Font' W-9 (such as legislation enacted after we release ft) is at wnvw.irspowlhvg. Purpose of Form An indrvidual or entity (Form W-9 requester) who is required to Wan information return with the Ins must obtain your correct taxpayer itlehhhteg0o number (TIM which may be your social security number (SSN), individual taxpayer identification number (MN). adoption taxpayer dentitcation nut (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information reams include. but we not kneed to. the fps:wing: • Form 1099.thif (interest earned or paid) • Form 1099.DIV (thindends, including those from stocks p mutual funds) • Form 1099.MISC (various types of income. Ines. awards, or gross proceeds) • Form 1099.9 (stock or mutual fund sales and certain other transactions by broker* • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest). 1098-E (student loan mlerelf). 1096-.7 Nihon) • Form 1099•C (canceled debt) • Form 1099-A (acquisition or abandonment of secured peopeny) Use Form W-9 only if you are a U.S. person (including a resident mien). to provide your correct TIN. gym; do not return Form W.9 to the requester with a TIN, you might be subject to backup withholding See Whet is backup withh0ldtrOT on page 2. By signing the filled-out form, you: 1. Certify that the TIN you we going is correct (or you are waiting for a number to be issued). 2. Certify that you we not sUbfeCt to backup withholding. or 3. Claw exemption from backup wrimording if you are a U.S. exempt payee. If applicable, you we also certifying mat as a U.S. person, your allocable share of any I:hennaing) income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectnely connected income, and 4. Certify that FATCA codels) entered on this form (if any) indicating that you we exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for hither information. Cal. No. 10231X Form W-9 (Rev. 12-2014) CONFIDENTIAL UBSTERRAMAR00002252 EFTA00237812