NEW ACCOUNT APPLICATION - Union Bank

2. PRIMARY ACCOUNT HOLDER (continued)LEGAL STREET ADDRESS (No P.O. Boxes)MAILING ADDRESS (If different from Legal Street Address)CITY STATE/PROVINCE ZIP/POSTAL CODE CITY STATE/PROVINCE ZIP/POSTAL CODECOUNTRYCOUNTRYIdentification -- Provide identification as requiredPrimary Account Owners/Signer -- Select one:Legal U.S. Resident Driver's License or any other government issued photo identification (specify type):Non U.S. Resident - Passport or any other foreign government issued photo identification that is written in English (specify type):Copy is required.Form of identification:TYPE OF GOVERNMENT ISSUED IDEmployer Information and AffiliationsEmployed RetiredEMPLOYMENT STATUSID NUMBERNot EmployedSTATE/COUNTRY OF ID ISSUANCEID ISSUANCE DATEID EXPIRATION DATENeither I, nor anyone bearing a financial interest or discretionaryauthority over this account is employed by, or affiliated with, a stockexchange or member firm of either an exchange, FINRA, or amunicipal securities broker/dealer UNLESS SPECIFIED BELOW:OCCUPATION (or former occupation, if retired)NAME OF FIRMEMPLOYER NAMETYPE OF BUSINESSADDRESS OF FIRMNotification of your intent to open an account will be sent to youremployer in accordance with current regulations.ADDRESSCITY STATE/PROVINCE ZIP/POSTAL CODEFor purposes of assisting your employer comply with SEC section16 reporting, please list a contact name and number whom UBISwill contact upon transactions executed in your public company'sstock.COUNTRYNAME OF FIRMTICKER SYMBOLI am a control person or a affiliate of a public company under SECRule 144 (such as a director, 10% shareholder, or policy-makingofficer), or an immediate family or household member of such.Know Your Client (KYC) ProfileClient Introduction1) How was the client introduced to UBIS:Referral from Union BankNAME OF REFERRERSolicitationReferral from existing UBIS clientNAME OF REFERRERUnsolicited Call-In2) Has the registered representative met withthe client(s)/account signer(s) in personand viewed their identification?Yes No3) Existing Union Bank Account/Relationship?Yes NoIf "Yes", Account Number:Account Funding SourceInitial Deposit$FUNDS$SECURITIESCONTACT NAMEPHONE NUMBERNAME OF FINANCIAL INSTITUTION(S) FUNDING THEACCOUNTCheck all that apply that describe the sourceof these funds:InvestmentsPersonal Income/Business RevenuePersonal/Business SavingsSale of Real Estate or Other PropertyLegal/Insurance SettlementInheritance/GiftsOther (specify):Purpose of AccountCheck all that apply that describe thepurpose of this account:Funding daily expensesLong term investment growthFunding retirementIntermediate investingFunding educationEstate PlanningBusiness Cash ManagementOther (specify):51047 (Rev. 06/2011) eformPage 2