EFTA00237340.pdf

UBS Financial Services Inc. UBS Ac :Will Number TIN Authorized Agent/Dual Signor Addendum To add an additional check user on the Resource Management Account. (BMA. ) a Business Services Account Else. complete the Authorized Agent for RMNBusiness Services Account BSA Check Wilting and the Account Holder Certification sections. To remove an authorized agent, complete the Authorized Agent Removal and the Account Holder Certification sections If the dual-signature option is selected on the Account Application, complete the Dual Signors for RIWV8usiness Services Account BSA Check Writing and the Account Holder Certification sections. The Account Holder must sign the Account Holder Certification section located on the next page. Authorized Agent for MA/Business Services Account BSA Check Writing Each additional check user (who is not a minor) named below is appointed an agent to me, unaffected by my subsequent disabity or incompetence, to effect checking transactions in my designated UBS Financial Services Inc. account As indicated below, the additional check user is authorized to act on my behalf to write checks for the payment or withdrawal of funds drawn on the designated U8S Financial Services Inc account or payable to me and bearing the signature or signatures now or hereafter authorized by me without limit as to amount, without inquiry and without regard to its application. UBS Financial Services Inc. will send all confirmations. notices, demands, statements and other communications regarding checking activity in the designated UBS Financial Services Inc. account to me. LISS Financial Services Inc owes no obligations to additional check users and may, but is not required to, act on instructions or respond to communications from such additional users. • • . • . . • Alan . Blecher •:Agent first Name Last Name Date of Birth SSO O.O ' . Country of Citizenship: g USA 0 Other (specify). Passport/Cedula: 11 (r, • . • . • . • Address line I Address Line 2 . . .' : .• : • United States of America City State/Province 2iprPostal Code Country Home Phone Additional fees may apply. Please see New Account booklet for details. Sign Here only if adding an authorized agent. Alan Blecher Agent First Name Last Name Agent Signature Date Authorized Agent Removal for MA/Business Services Account BSA Check Writing If you are removing an authorized agent, please print the name of the agent you are removing below Specify Name only if removing an agent Daniel Kesner Agent First Name Last Name 015943462/ 1 C A • / AC-RW (Rev 10/15 02015 U85 Financial Services Inc. All ights reserved. Member SIPC. Page 1/2 CONFIDENTIAL UBSTERFtAMAR00001703 EFTA00237340