PLEASE SELECT ONE OF THE FOLLOWING OPTIONS. Reinvest dividends on ALL eligible securities. Please do not reinvest any dividends. When you enroll your account in E-Docs, you will receive trade confirmations, account statements, tax-related documents, proxies, prospectuses, annual reports, and all other eligible account documents electronically. An e-mail notification will be sent to the Account Owner’s e-mail address on the same day that any electronic documents become available. Just log into your account to access E-Docs and view, print, or download your electronic documents. PLEASE SEE YOUR INVESTMENT REPRESENTATIVE FOR ENROLLMENT INFORMATION. SERVICE INSTRUCTIONS (Voluntary Sweep Program) DIRECT COMMUNICATION RULE 14b-1(c) Select whether or not you would like to enroll your account into the Sweep Program. By enrolling in the Sweep Program, your credit balances, including dividends and proceeds from the sale of securities that are credited to your account, will automatically be swept. YES No By selecting ‘yes,’ I (We) acknowledge that I (We) have read the Sweep Program provision of the Customer Account Agreement and have been made aware of the general terms and conditions of the products available through the sweep program. Other alternatives for dividend distribution or requests for physical certificate delivery may be available. Contact your investment representative. Rule 14b-1(c) of the Securities Exchange Act, unless you object, requires us to disclose to an issuer, upon its request, the names, addresses, and securities positions of our customers who are beneficial owners of the issuer’s securities, held by us in nominee name. The issuer would be permitted to use your name and other related information for corporation communication only. If you object to this disclosure, check the box below. Yes, I do object to the disclosure of such information. IS THE ACCOUNT MAINTAINED FOR A CURRENT OR FORMER POLITICALLY EXPOSED PERSON OR PUBLIC OFFICIAL? (Includes U.S. & Foreign Individuals) YES No ADDITIONAL ACCOUNT INFORMATION IF YES, PLEASE PROVIDE THE NAMES OF THAT OFFICAL AND OFFICIAL’S IMMEDIATE FAMILY MEMBERS. (Including Former Spouses) IF YES, PLEASE PROVIDE THE NAME OF THE RELATED POLITICAL ORGANIZATION. IS THE ACCOUNT MAINTAINED FOR A FOREIGN FINANCIAL INSTITUTION AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please complete the ‘Foreign Financial Institution Due Diligence Questionnaire’ Form) IS THE ACCOUNT A FOREIGN BANK ORGANIZED UNDER FOREIGN LAW AND LOCATED OUTSIDE OF THE UNITED STATES AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please ensure the “Certification Regarding Correspondent Accounts” is complete in addition to the “Foreign Financial Institution Due Diligence Questionnaire” Form) NOTE: Broker-Dealers are prohibited from establishing, maintaining, administering, or managing correspondent accounts in the United States for Foreign Xxxxx Xxxxx. The prohibition does not include Foreign Shell Banks that are regulated affiliates. IF YES, PLEASE LIST U.S. AGENT FOR SERVICE OF PROCESS. OFFICIAL & IMMEDIATE FAMILY MEMBER(S) POLITICAL ORGANIZATION YES No YES No U.S. AGENT W-9 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) 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 FATCA reporting is correct. Definition of a U.S. person. For federal tax return purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, an estate (other than a foreign estate), or a domestic trust (as defined in Regulations section 301.7701-7). The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. EXCEPTIONS (See Instructions) EXEMPT PAYEE CODE (If Any): EXEMPTION FROM FATCA REPORTING CODE (If Any): SIGNATURES I authorize my broker and/or Clearing Firm to obtain a consumer report at the time of application to verify my creditworthiness and to obtain a consumer report from time to time for updates, renewals, extensions, and collection activity on any approved account. Upon my written request, my broker and/or Clearing Firm will disclose to me whether it obtained a report, and if so, the name and address of the consumer-reporting agency that provided it. In the event that my account is denied by Clearing Firm, as a result of the consumer report verification, I authorize Clearing Firm to provide to my broker the reason(s) for such denial. BY SIGNING THIS APPLICATION, I (WE) ACKNOWLEDGE THE FOLLOWING (1) THAT, PAGE 4 PARAGRAPH 8 OF THE CUSTOMER ACCOUNT AGREEMEN T CONTAINS A PREDISPUTE ARBITRATION CLAUSE AND IN ACCORDANCE WITH THIS AGREEMENT I (WE) AGREE IN ADVANCE TO ARBITRATE ANY CONTROVERSIES WHICH MAY ARISE BETWEEN OR AMONG ME (US), MY BROKER, AND/OR CLEARING FIRM, (2) RECEIPT OF A COPY OF THE CUSTOMER ACCOUNT AGREEMENT FOLLOWING THIS APPLICATION AND MY (OUR) AGREEMENT WITH THE TERMS THEREIN AND (3) THE INFORMATIO N PROVIDED ABOVE IS ACCURATE. SIGNATURE DATE SIGNATURE OF JOINT APPLICANT DATE FOR JOINT ACCOUNTS BOTH PARTIES MUST SIGN FORM FOR OFFICE USE ONLY FIRST TRADE [IB] BRANCH MANAGER APPROVAL CUSTOMER I.D. VERIFIED (Must be completed) Yes [IB] REPRESENTATIVE SIGNATURE DATE OPENED CERTIFICA TE OF TRUST & INVESTMENT POWERS In consideration of you and Apex Clearing Corporation (“Clearing Firm”) opening and maintaining one or more accounts for the Trust, the undersigned Trustee(s) certify, represent and warrant that the Trust is in full force and effect and that the Trust Agreement has not been revoked, amended or modified in any manner that would render this certification inaccurate. The Trustee(s) further represent and agree that the following information is true, complete and accurate. ACCOUNT NUMBER DATE TRUST TITLE DATE OF TRUST THE TRUST IS GOVERENED BY THE LAW OF THE STATE OF THE TRUST IS Revocable & Amendable Irrevocable LIST OF ALL CURRENT TRUSTEES 1 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 2 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 3 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 4 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS CERTIFICATE OF TRUST & INVESTMENT POWERS In addition to the Trustee(s), you and Clearing Firm may accept orders and other instructions relative to the Trust Account(s) from the individuals or entities listed below. Those individuals or entities may execute any documents on behalf of the Trusts and, unless otherwise specified, anyone of the listed individuals or entities mayact individuallyon behalf of the Trust. Power of the Trustee(s) The Trustee(s) certify andrepresent that the Trust Agreement authorizes each Trustee to act independently and without providing you and Clearing Firm with consent of the other Trustee(s) for all purposes related to maintaining this Trust Account or that the Trustee(s) so acting has obtained the requisite consent of the other Trustee(s) in accordance with the terms of the Trust Agreement. The Trustee(s) represent that you and Clearing Firm is authorized to follow, without limitation, the instructions of any Trustee(s) including, but not limited to, the signing of all account agreements anddocuments on behalf of the Trust, directions to deliver or transfer funds, securities or other assets, the endorsement of checks and to enter into transactions for the purchase or sale of securities insurance and annuity contracts and other investments. The Trustee(s) further represent that the Trust Agreement authorizes (check all that apply): To maintaina Margin and Short Account andthrough such account to borrow funds to purchase securities on margin, sell securities which the Trust does not own (i.e. short sales) andto borrow securities inconnection therewith. (Request Margin Documentation) To trade in option contracts, including, without limitations, the purchase of puts andcalls and the writing (sale) of covered and uncovered puts and calls. (Request Option Documentation) The Trustee(s) certifyand represent that the informationprovided in the Trust Account Application and other account paper-work has been reviewed by the Trustee(s) and is true and correct as of the date of this certification andthat the Trustee(s) agree to notify you and Clearing Firm promptly of any amendments to the Trust, and change to the composition of the Trustees or any other even which could alter this certification. This certification supersedes any prior certification and youand Clearing Firm may rely on it until receipt of a new certification. The Trustee(s) agree that you and Clearing Firm is not responsible for reviewing or determining the propriety of instructions received by any Trustee and may rely on those instructions, without confirming them with any other Trustee. Notice sent to one Trustee, including notice sent electronically, shall constitute notice to all Trustees. The Trustees hereby jointly and severally agree to indemnify you and Clearing Firm and each of its affiliates, offices, directors, employees, and agents from and hold such persons harmless against, any claims, judgments, expenses, liabilities or costs of defense or settlement (including attorney’s fees) arising out of relating to breachof any representation or warranty made hereinor to any actual or alleged improper or unsuitable actions taken upon such Trustees instructions inconnection with the brokerage account established at you and Clearing Firm for the Trust. This indemnification shall not be limited in any way by the Trustees provision you and Clearing Firm of independent documentationconcerning the representations made herein. The representations and obligations stated hereinshall survive termination of the Trust Agreement and any Account Agreement relating to the Trust’s brokerage account. Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Authorized Trading Trustee Information Name: Title in Organization: (President, Trustee, Partner, Executor, etc.) Social Security Number: Date of Birth: (Month/Day/Year) Marital Status: ( ) Single ( ) Married ( ) Divorced ( ) Widowed Home Address: _ City State Zip Code Telephone: Employer: Occupation/Position: __ Years Employed: Type of Business: Employer Address: _ City State Zip Code Telephone: _
Appears in 2 contracts
Samples: Electronic Services Agreement, Electronic Services Agreement
PLEASE SELECT ONE OF THE FOLLOWING OPTIONS. Reinvest dividends on ALL eligible securities. Please do not reinvest any dividends. When you enroll your account in E-Docs, you will receive trade confirmations, account statements, tax-related documents, proxies, prospectuses, annual reports, and all other eligible account documents electronically. An e-mail notification will be sent to the Account Owner’s e-mail address on the same day that any electronic documents become available. Just log into your account to access E-Docs and view, print, or download your electronic documents. PLEASE SEE YOUR INVESTMENT REPRESENTATIVE FOR ENROLLMENT INFORMATION. SERVICE INSTRUCTIONS (Voluntary Sweep Program) DIRECT COMMUNICATION RULE 14b-1(c) Select whether or not you would like to enroll your account into the Sweep Program. By enrolling in the Sweep Program, your credit balances, including dividends and proceeds from the sale of securities that are credited to your account, will automatically be swept. YES No By selecting ‘yes,’ I (We) acknowledge that I (We) have read the Sweep Program provision of the Customer Account Agreement and have been made aware of the general terms and conditions of the products available through the sweep program. Other alternatives for dividend distribution or requests for physical certificate delivery may be available. Contact your investment representative. Rule 14b-1(c) of the Securities Exchange Act, unless you object, requires us to disclose to an issuer, upon its request, the names, addresses, and securities positions of our customers who are beneficial owners of the issuer’s securities, held by us in nominee name. The issuer would be permitted to use your name and other related information for corporation communication only. If you object to this disclosure, check the box below. Yes, I do object to the disclosure of such information. IS THE ACCOUNT MAINTAINED FOR A CURRENT OR FORMER POLITICALLY EXPOSED PERSON OR PUBLIC OFFICIAL? (Includes U.S. & Foreign Individuals) YES No ADDITIONAL ACCOUNT INFORMATION IF YES, PLEASE PROVIDE THE NAMES OF THAT OFFICAL AND OFFICIAL’S IMMEDIATE FAMILY MEMBERS. (Including Former Spouses) IF YES, PLEASE PROVIDE THE NAME OF THE RELATED POLITICAL ORGANIZATION. IS THE ACCOUNT MAINTAINED FOR A FOREIGN FINANCIAL INSTITUTION AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please complete the ‘Foreign Financial Institution Due Diligence Questionnaire’ Form) IS THE ACCOUNT A FOREIGN BANK ORGANIZED UNDER FOREIGN LAW AND LOCATED OUTSIDE OF THE UNITED STATES AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please ensure the “Certification Regarding Correspondent Accounts” is complete in addition to the “Foreign Financial Institution Due Diligence Questionnaire” Form) NOTE: Broker-Dealers are prohibited from establishing, maintaining, administering, or managing correspondent accounts in the United States for Foreign Xxxxx Xxxxx. The prohibition does not include Foreign Shell Banks that are regulated affiliates. IF YES, PLEASE LIST U.S. AGENT FOR SERVICE OF PROCESS. OFFICIAL & IMMEDIATE FAMILY MEMBER(S) POLITICAL ORGANIZATION YES No YES No U.S. AGENT W-9 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) 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 FATCA reporting is correct. Definition of a U.S. person. For federal tax return purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, an estate (other than a foreign estate), or a domestic trust (as defined in Regulations section 301.7701-7). The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. EXCEPTIONS (See Instructions) EXEMPT PAYEE CODE (If Any): EXEMPTION FROM FATCA REPORTING CODE (If Any): SIGNATURES I authorize my broker and/or Clearing Firm to obtain a consumer report at the time of application to verify my creditworthiness and to obtain a consumer report from time to time for updates, renewals, extensions, and collection activity on any approved account. Upon my written request, my broker and/or Clearing Firm will disclose to me whether it obtained a report, and if so, the name and address of the consumer-reporting agency that provided it. In the event that my account is denied by Clearing Firm, as a result of the consumer report verification, I authorize Clearing Firm to provide to my broker the reason(s) for such denial. BY SIGNING THIS APPLICATION, I (WE) ACKNOWLEDGE THE FOLLOWING (1) THAT, PAGE 4 PARAGRAPH 8 OF THE CUSTOMER ACCOUNT AGREEMEN T CONTAINS A PREDISPUTE ARBITRATION CLAUSE AND IN ACCORDANCE WITH THIS AGREEMENT I (WE) AGREE IN ADVANCE TO ARBITRATE ANY CONTROVERSIES WHICH MAY ARISE BETWEEN OR AMONG ME (US), MY BROKER, AND/OR CLEARING FIRM, (2) RECEIPT OF A COPY OF THE CUSTOMER ACCOUNT AGREEMENT FOLLOWING THIS APPLICATION AND MY (OUR) AGREEMENT WITH THE TERMS THEREIN AND (3) THE INFORMATIO N PROVIDED ABOVE IS ACCURATE. SIGNATURE DATE SIGNATURE OF JOINT APPLICANT DATE FOR JOINT ACCOUNTS BOTH PARTIES MUST SIGN FORM FOR OFFICE USE ONLY FIRST TRADE [IB] BRANCH MANAGER APPROVAL CUSTOMER I.D. VERIFIED (Must be completed) Yes [IB] REPRESENTATIVE SIGNATURE DATE OPENED CERTIFICA TE OF TRUST & INVESTMENT POWERS In consideration of you and Apex Clearing Corporation (“Clearing Firm”) opening and maintaining one or more accounts for the Trust, the undersigned Trustee(s) certify, represent and warrant that the Trust is in full force and effect and that the Trust Agreement has not been revoked, amended or modified in any manner that would render this certification inaccurate. The Trustee(s) further represent and agree that the following information is true, complete and accurate. ACCOUNT NUMBER DATE TRUST TITLE DATE OF TRUST THE TRUST IS GOVERENED BY THE LAW OF THE STATE OF THE TRUST IS Revocable & Amendable Irrevocable LIST OF ALL CURRENT TRUSTEES 1 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 2 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 3 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 4 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS CERTIFICATE OF TRUST & INVESTMENT POWERS In addition to the Trustee(s), you and Clearing Firm may accept orders and other instructions relative to the Trust Account(s) from the individuals or entities listed below. Those individuals or entities may execute any documents on behalf of the Trusts and, unless otherwise specified, anyone of the listed individuals or entities mayact individuallyon behalf of the Trust. Power of the Trustee(s) The Trustee(s) certify andrepresent that the Trust Agreement authorizes each Trustee to act independently and without providing you and Clearing Firm with consent of the other Trustee(s) for all purposes related to maintaining this Trust Account or that the Trustee(s) so acting has obtained the requisite consent of the other Trustee(s) in accordance with the terms of the Trust Agreement. The Trustee(s) represent that you and Clearing Firm is authorized to follow, without limitation, the instructions of any Trustee(s) including, but not limited to, the signing of all account agreements anddocuments on behalf of the Trust, directions to deliver or transfer funds, securities or other assets, the endorsement of checks and to enter into transactions for the purchase or sale of securities insurance and annuity contracts and other investments. The Trustee(s) further represent that the Trust Agreement authorizes (check all that apply): To maintaina Margin and Short Account andthrough such account to borrow funds to purchase securities on margin, sell securities which the Trust does not own (i.e. short sales) andto borrow securities inconnection therewith. (Request Margin Documentation) To trade in option contracts, including, without limitations, the purchase of puts andcalls and the writing (sale) of covered and uncovered puts and calls. (Request Option Documentation) The Trustee(s) certifyand represent that the informationprovided in the Trust Account Application and other account paper-work has been reviewed by the Trustee(s) and is true and correct as of the date of this certification andthat the Trustee(s) agree to notify you and Clearing Firm promptly of any amendments to the Trust, and change to the composition of the Trustees or any other even which could alter this certification. This certification supersedes any prior certification and youand Clearing Firm may rely on it until receipt of a new certification. The Trustee(s) agree that you and Clearing Firm is not responsible for reviewing or determining the propriety of instructions received by any Trustee and may rely on those instructions, without confirming them with any other Trustee. Notice sent to one Trustee, including notice sent electronically, shall constitute notice to all Trustees. The Trustees hereby jointly and severally agree to indemnify you and Clearing Firm and each of its affiliates, offices, directors, employees, and agents from and hold such persons harmless against, any claims, judgments, expenses, liabilities or costs of defense or settlement (including attorney’s fees) arising out of relating to breachof any representation or warranty made hereinor to any actual or alleged improper or unsuitable actions taken upon such Trustees instructions inconnection with the brokerage account established at you and Clearing Firm for the Trust. This indemnification shall not be limited in any way by the Trustees provision you and Clearing Firm of independent documentationconcerning the representations made herein. The representations and obligations stated hereinshall survive termination of the Trust Agreement and any Firstrade Account Agreement relating to the Trust’s brokerage account. Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Authorized Trading Trustee Information Name: Title in Organization: (President, Trustee, Partner, Executor, etc.) Social Security Number: Date of Birth: (Month/Day/Year) Marital Status: ( ) Single ( ) Married ( ) Divorced ( ) Widowed Home Address: _ City State Zip Code Telephone: Employer: Occupation/Position: __ Years Employed: Type of Business: Employer Address: _ City State Zip Code Telephone: _Member FINRA & SIPC
Appears in 1 contract
Samples: Electronic Services Agreement
PLEASE SELECT ONE OF THE FOLLOWING OPTIONS. Reinvest dividends on ALL eligible securities. Please do not reinvest any dividends. When you enroll your account in E-Docs, you will receive trade confirmations, account statements, tax-related documents, proxies, prospectuses, annual reports, and all other eligible account documents electronically. An e-mail notification will be sent to the Account Owner’s e-mail address on the same day that any electronic documents become available. Just log into your account to access E-Docs and view, print, or download your electronic documents. PLEASE SEE YOUR INVESTMENT REPRESENTATIVE FOR ENROLLMENT INFORMATION. SERVICE INSTRUCTIONS (Voluntary Sweep Program) DIRECT COMMUNICATION RULE 14b-1(c) Select whether or not you would like to enroll your account into the Sweep Program. By enrolling in the Sweep Program, your credit balances, including dividends and proceeds from the sale of securities that are credited to your account, will automatically be swept. YES No By selecting ‘yes,’ I (We) acknowledge that I (We) have read the Sweep Program provision of the Customer Account Agreement and have been made aware of the general terms and conditions of the products available through the sweep program. Other alternatives for dividend distribution or requests for physical certificate delivery may be available. Contact your investment representative. Rule 14b-1(c) of the Securities Exchange Act, unless you object, requires us to disclose to an issuer, upon its request, the names, addresses, and securities positions of our customers who are beneficial owners of the issuer’s securities, held by us in nominee name. The issuer would be permitted to use your name and other related information for corporation communication only. If you object to this disclosure, check the box below. Yes, I do object to the disclosure of such information. IS THE ACCOUNT MAINTAINED FOR A CURRENT OR FORMER POLITICALLY EXPOSED PERSON OR PUBLIC OFFICIAL? (Includes U.S. & Foreign Individuals) YES No ADDITIONAL ACCOUNT INFORMATION IF YES, PLEASE PROVIDE THE NAMES OF THAT OFFICAL AND OFFICIAL’S IMMEDIATE FAMILY MEMBERS. (Including Former Spouses) IF YES, PLEASE PROVIDE THE NAME OF THE RELATED POLITICAL ORGANIZATION. IS THE ACCOUNT MAINTAINED FOR A FOREIGN FINANCIAL INSTITUTION AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please complete the ‘Foreign Financial Institution Due Diligence Questionnaire’ Form) IS THE ACCOUNT A FOREIGN BANK ORGANIZED UNDER FOREIGN LAW AND LOCATED OUTSIDE OF THE UNITED STATES AS DEFINED BY TITLE 31 OF THE CODE OF FEDERAL REGULATIONS? (If Yes, Please ensure the “Certification Regarding Correspondent Accounts” is complete in addition to the “Foreign Financial Institution Due Diligence Questionnaire” Form) NOTE: Broker-Dealers are prohibited from establishing, maintaining, administering, or managing correspondent accounts in the United States for Foreign Xxxxx Xxxxx. The prohibition does not include Foreign Shell Banks that are regulated affiliates. IF YES, PLEASE LIST U.S. AGENT FOR SERVICE OF PROCESS. OFFICIAL & IMMEDIATE FAMILY MEMBER(S) POLITICAL ORGANIZATION YES No YES No U.S. AGENT W-9 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) 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 FATCA reporting is correct. Definition of a U.S. person. For federal tax return purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, an estate (other than a foreign estate), or a domestic trust (as defined in Regulations section 301.7701-7). The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding. EXCEPTIONS (See Instructions) EXEMPT PAYEE CODE (If Any): EXEMPTION FROM FATCA REPORTING CODE (If Any): SIGNATURES I authorize my broker and/or Clearing Firm to obtain a consumer report at the time of application to verify my creditworthiness and to obtain a consumer report from time to time for updates, renewals, extensions, and collection activity on any approved account. Upon my written request, my broker and/or Clearing Firm will disclose to me whether it obtained a report, and if so, the name and address of the consumer-reporting agency that provided it. In the event that my account is denied by Clearing Firm, as a result of the consumer report verification, I authorize Clearing Firm to provide to my broker the reason(s) for such denial. BY SIGNING THIS APPLICATION, I (WE) ACKNOWLEDGE THE FOLLOWING (1) THAT, PAGE 4 PARAGRAPH 8 OF THE CUSTOMER ACCOUNT AGREEMEN T AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE AND IN ACCORDANCE WITH THIS AGREEMENT I (WE) AGREE IN ADVANCE TO ARBITRATE ANY CONTROVERSIES WHICH MAY ARISE BETWEEN OR AMONG ME (US), MY BROKER, AND/OR CLEARING FIRM, (2) RECEIPT OF A COPY OF THE CUSTOMER ACCOUNT AGREEMENT FOLLOWING THIS APPLICATION AND MY (OUR) AGREEMENT WITH THE TERMS THEREIN AND (3) THE INFORMATIO N INFORMATION PROVIDED ABOVE IS ACCURATE. SIGNATURE DATE SIGNATURE OF JOINT APPLICANT DATE FOR JOINT ACCOUNTS BOTH PARTIES MUST SIGN FORM FOR OFFICE USE ONLY FIRST TRADE [IB] BRANCH MANAGER APPROVAL CUSTOMER I.D. VERIFIED (Must be completed) Yes [IB] REPRESENTATIVE SIGNATURE DATE OPENED CERTIFICA TE OF TRUST & INVESTMENT POWERS In consideration CUSTOMER ACCOUNT AGREEMENT This Customer Account Agreement (the “Agreement”) sets forth the respective rights and obligations of you and Apex Clearing Corporation (“Clearing Firmyou” or “your” or “Apex”) opening and maintaining one or more accounts the Customer’s (as defined below) brokerage firm (the “Introducing Broker”), and the customer(s) identified on the New Account Application (the “Customer”) in connection with the Customer’s brokerage account with the Introducing Broker (“the Account”). The Customer hereby agrees as follows with respect to the Account, which the Customer has established with the Introducing Broker for the Trustpurchase, sale or carrying of securities or contracts relating thereto and/or the borrowing of funds, which transactions are cleared through you. To help the government fight the funding of terrorism and money laundering, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. In order to open an account, the undersigned Trustee(s) certify, represent and warrant Customer will provide information that will allow you to identify the Trust is in full force and effect and that the Trust Agreement has not been revoked, amended or modified in any manner that would render this certification inaccurate. The Trustee(s) further represent and agree that the following information is true, complete and accurate. ACCOUNT NUMBER DATE TRUST TITLE DATE OF TRUST THE TRUST IS GOVERENED BY THE LAW OF THE STATE OF THE TRUST IS Revocable & Amendable Irrevocable LIST OF ALL CURRENT TRUSTEES 1 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 2 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 3 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS 4 NAME & TITLE ID # SIGNATURE ID TYPE SSN, FED ID, CEDULA, NIT # ISSUED BY DATE OF BIRTH ISSUE DATE EXPIRATION DATE ADDRESS CERTIFICATE OF TRUST & INVESTMENT POWERS In addition to the Trustee(s), you and Clearing Firm may accept orders and other instructions relative to the Trust Account(s) from the individuals or entities listed below. Those individuals or entities may execute any documents on behalf of the Trusts and, unless otherwise specified, anyone of the listed individuals or entities mayact individuallyon behalf of the Trust. Power of the Trustee(s) The Trustee(s) certify andrepresent that the Trust Agreement authorizes each Trustee to act independently and without providing you and Clearing Firm with consent of the other Trustee(s) for all purposes related to maintaining this Trust Account or that the Trustee(s) so acting has obtained the requisite consent of the other Trustee(s) in accordance with the terms of the Trust Agreement. The Trustee(s) represent that you and Clearing Firm is authorized to follow, without limitation, the instructions of any Trustee(s) Customer including, but not limited to, the signing Customer’s name, address, date of all account agreements anddocuments on behalf of birth, and the Trust, directions to deliver or transfer funds, securities Customer’s driver’s license or other assets, the endorsement of checks and to enter into transactions for the purchase or sale of securities insurance and annuity contracts and other investments. The Trustee(s) further represent that the Trust Agreement authorizes (check all that apply): To maintaina Margin and Short Account andthrough such account to borrow funds to purchase securities on margin, sell securities which the Trust does not own (i.e. short sales) andto borrow securities inconnection therewith. (Request Margin Documentation) To trade in option contracts, including, without limitations, the purchase of puts andcalls and the writing (sale) of covered and uncovered puts and calls. (Request Option Documentation) The Trustee(s) certifyand represent that the informationprovided in the Trust Account Application and other account paper-work has been reviewed by the Trustee(s) and is true and correct as of the date of this certification andthat the Trustee(s) agree to notify you and Clearing Firm promptly of any amendments to the Trust, and change to the composition of the Trustees or any other even which could alter this certification. This certification supersedes any prior certification and youand Clearing Firm may rely on it until receipt of a new certification. The Trustee(s) agree that you and Clearing Firm is not responsible for reviewing or determining the propriety of instructions received by any Trustee and may rely on those instructions, without confirming them with any other Trustee. Notice sent to one Trustee, including notice sent electronically, shall constitute notice to all Trustees. The Trustees hereby jointly and severally agree to indemnify you and Clearing Firm and each of its affiliates, offices, directors, employees, and agents from and hold such persons harmless against, any claims, judgments, expenses, liabilities or costs of defense or settlement (including attorney’s fees) arising out of relating to breachof any representation or warranty made hereinor to any actual or alleged improper or unsuitable actions taken upon such Trustees instructions inconnection with the brokerage account established at you and Clearing Firm for the Trust. This indemnification shall not be limited in any way by the Trustees provision you and Clearing Firm of independent documentationconcerning the representations made herein. The representations and obligations stated hereinshall survive termination of the Trust Agreement and any Account Agreement relating to the Trust’s brokerage account. Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Trustee Signature Print Trustee’s Name Authorized Trading Trustee Information Name: Title in Organization: (President, Trustee, Partner, Executor, etcidentifying documents.) Social Security Number: Date of Birth: (Month/Day/Year) Marital Status: ( ) Single ( ) Married ( ) Divorced ( ) Widowed Home Address: _ City State Zip Code Telephone: Employer: Occupation/Position: __ Years Employed: Type of Business: Employer Address: _ City State Zip Code Telephone: _
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Samples: Account Agreement
