NEW ACCOUNT APPLICATION - Union Bank
NEW ACCOUNT APPLICATION - Union Bank NEW ACCOUNT APPLICATION - Union Bank
5. ADDITIONAL ACCOUNT HOLDERSUse this section to provide personal information on any additional individuals associated with this account (such as a joint owner, authorizedindividual, minor, administrator, trustee, partner, or participant).Copy and complete this page for each additional owner. Number each copied page as follows: 6.1, 6.2, 6.3 etc.Personal InformationNAME OF ACCOUNT HOLDER, ENTITY NAME, MINOR, TRUSTEEDATE OF BIRTH (MM/DD/YYYY)United StatesResident AlienNon-Resident Alien*(W-8 Form required)CITIZENSHIPCOUNTRY OF CITIZENSHIP (If Resident or Non-Resident Alien)HOME PHONE NUMBERBUSINESS PHONE NUMBERSOCIAL SECURITY NUMBER or TAX ID NUMBERCOUNTRY OF TAX RESIDENCESingle/Divorced/WidowedMarriedNo. of Dependents:MARITAL STATUSEMAIL ADDRESSLEGAL STREET ADDRESS (No P.O. Boxes)MAILING ADDRESS (If different from Legal Street Address)CITY STATE/PROVINCE ZIP/POSTAL CODECITY STATE/PROVINCE ZIP/POSTAL CODECOUNTRYCOUNTRYIdentification -- Provide identification as requiredAdditional 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 ID ID NUMBERSTATE/COUNTRY OF ID ISSUANCE ID ISSUANCE DATE ID EXPIRATION DATEEmployer Information and AffiliationsEmployed Retired Not EmployedEMPLOYMENT STATUSNeither I, nor anyone bearing a financial interest or discretionaryauthority over this account is employed by, or affiliated with, astock exchange 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.COUNTRYI 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.NAME OF FIRMCONTACT NAMEPHONE NUMBERTICKER SYMBOL*These account types are not eligible for the Bank Deposit Sweep Program. These accounts will default to the HighMark DiversifiedMoney Market Fund. Other account types may have eligibility restrictions based upon beneficial ownership and beneficiaries.51047 (Rev. 06/2011) eformPage 6
6. TRANSFER ON DEATH (TOD) BENEFICIARY INFORMATIONThis section is required for Transfer on Death, Custodial, Estate, Trust and Non Prototype accounts, and does not apply to other types ofaccounts.Share percentages must total 100% for primary and 100% for contingent. Use percentages only, not dollar amounts.Before making a Per Stirpes designation, consult with an estate planning attorney and see the Customer Agreement for important information. Ifyou make any Per Stirpes designation, provide name of executor or other contact:CONTACT/EXECUTOR NAMEIf beneficiary is a trust, provide trust name, names of all trustees, beneficiaries, and date trust was established.PRIMARY Beneficiaries/FBOCONTINGENT BeneficiariesNAME OF BENEFICIARYNAME OF BENEFICIARYSpouse Non-Spouse Trust EntitySpouse Non-Spouse Trust EntityCHECK ONECHECK ONESOCIAL SECURITY NUMBER OR TAXPAYER ID NO.DATE OF BIRTH/TRUST (MM/DD/YYYY)SOCIAL SECURITY NUMBER OR TAXPAYER ID NO.DATE OF BIRTH/TRUST (MM/DD/YYYY)COUNTRY OF CITIZENSHIP/ORGANIZATION% SHARECOUNTRY OF CITIZENSHIP/ORGANIZATION% SHARENAME OF TRUSTEES (if applicable)Per StirpesNAME OF TRUSTEES (if applicable)Per StirpesNAME OF BENEFICIARYNAME OF BENEFICIARYSpouse Non-Spouse Trust EntitySpouse Non-Spouse Trust EntityCHECK ONECHECK ONESOCIAL SECURITY NUMBER OR TAXPAYER ID NO.DATE OF BIRTH/TRUST (MM/DD/YYYY)SOCIAL SECURITY NUMBER OR TAXPAYER ID NO.DATE OF BIRTH/TRUST (MM/DD/YYYY)COUNTRY OF CITIZENSHIP/ORGANIZATION% SHARECOUNTRY OF CITIZENSHIP/ORGANIZATION% SHARENAME OF TRUSTEES (if applicable)Per StirpesNAME OF TRUSTEES (if applicable)Per Stirpes7. CUSTOMER AGREEMENT AND SIGNATURENotice to National Financial Services, LLCThis is to advise you that I have instructed UnionBanc Investment Services LLC to establish, in my behalf, an account with you. I haveappointed UnionBanc Investment Services LLC as my exclusive agent to act for and on my behalf with respect to all matters regarding myaccount with you, including but not limited to the placing of securities, purchase and sale orders, the selection of my Core Account InvestmentVehicle, including a Bank Deposit Sweep Program and to act in all respects in connection with such Core Account Investment Vehicle, providemargin and/or option trading approved for the account, delivery of margin and or option instructions for my (our) account. I acknowledge thatno fiduciary relationship exists. You shall look solely to UnionBanc Investment Services LLC and not me with respect to any such orders orinstructions, and you are hereby instructed to deliver confirmations, statements, and all written or other notices, with respect to my account, toUnionBanc Investment Services LLC. Any such communications delivered to UnionBanc Investment Services LLC shall be deemed to have beendelivered to me, and you shall be entitled to rely on UnionBanc Investment Services LLC to forward the substance of any such communicationsto me. I agree to hold you harmless from and against any losses, costs, or expenses arising in connection with the delivery or receipt of anysuch communication(s), provided you have acted in accordance with the above. The foregoing shall be effective as to my account until writtennotice to the contrary is received by you and by UnionBanc Investment Services LLC.51047 (Rev. 06/2011) eformPage 7
- Page 1 and 2: NEW ACCOUNT APPLICATIONPlease Print
- Page 3 and 4: 2. PRIMARY ACCOUNT HOLDER (continue
- Page 5: 4. ACCOUNT CHARACTERISTICSCore Acco
5. ADDITIONAL <strong>ACCOUNT</strong> HOLDERSUse this section to provide personal information on any additional individuals associated with this account (such as a joint owner, authorizedindividual, minor, administrator, trustee, partner, or participant).Copy and complete this page for each additional owner. Number each copied page as follows: 6.1, 6.2, 6.3 etc.Personal InformationNAME OF <strong>ACCOUNT</strong> HOLDER, ENTITY NAME, MINOR, TRUSTEEDATE OF BIRTH (MM/DD/YYYY)United StatesResident AlienNon-Resident Alien*(W-8 Form required)CITIZENSHIPCOUNTRY OF CITIZENSHIP (If Resident or Non-Resident Alien)HOME PHONE NUMBERBUSINESS PHONE NUMBERSOCIAL SECURITY NUMBER or TAX ID NUMBERCOUNTRY OF TAX RESIDENCESingle/Divorced/WidowedMarriedNo. of Dependents:MARITAL STATUSEMAIL ADDRESSLEGAL STREET ADDRESS (No P.O. Boxes)MAILING ADDRESS (If different from Legal Street Address)CITY STATE/PROVINCE ZIP/POSTAL CODECITY STATE/PROVINCE ZIP/POSTAL CODECOUNTRYCOUNTRYIdentification -- Provide identification as requiredAdditional 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 ID ID NUMBERSTATE/COUNTRY OF ID ISSUANCE ID ISSUANCE DATE ID EXPIRATION DATEEmployer Information and AffiliationsEmployed Retired Not EmployedEMPLOYMENT STATUSNeither I, nor anyone bearing a financial interest or discretionaryauthority over this account is employed by, or affiliated with, astock exchange 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.COUNTRYI 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.NAME OF FIRMCONTACT NAMEPHONE NUMBERTICKER SYMBOL*These account types are not eligible for the <strong>Bank</strong> Deposit Sweep Program. These accounts will default to the HighMark DiversifiedMoney Market Fund. Other account types may have eligibility restrictions based upon beneficial ownership and beneficiaries.51047 (Rev. 06/2011) eformPage 6
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