EFTA01125044.pdf

FIRST PRIVATE EQUITY GROUP PETER LEVINE SENIOR TRADING ADVISOR AMERICAN INTERNATIONAL BUILDING 70 PINE STREET NEW YORK, NY 10005 FAX: TEL HTTP://WWW.FPEGWEB.COM EFTA01125044  REilT PRIVATE American International Building EQUITY GROUP 70 Pine St. New York. NY, 10005 Tel: (+1) Fax: (+1) Account Opening Kit Guidance Notes Please write clearly in the white spaces with Please sign and date as required and return to: Capital letters or ticks the boxes. Fax: (+1) Contents This Account Opening Kit includes all relevant documentation to formally commence your investment. To Open the Account you will need to complete each of the following: 1. Account Opening Form: So that we can offer our clients the best available advice, we ask that you complete your personal details and return the form signed and dated. 2. Terms of Agreement: A detailed review of our operating processes which will outline the way we can work effectively on your behalf. 3. Confidentiality Agreement: As a client of the company. you will have access to company information which may be sensitive. To preserve the integrity of this information and to ensure that this information is not used for external economic gain, First Private Equity Group, requires signing of this Confidentiality Agreement. 4. W8-BEN Form: To register foreign status and to ensure you are exempt from US taxes and fees associated with this investment account. This document will be included as a separate attachment. You will also receive: 5. Funding Instructions: This is how you will fund your account opening. Section 4 of this Account Opening Kit details the relevant instructions for international bank-to-bank transfer. Use this document to ensure correct remittance details. To settle the account. our oavment details are provided and should be followed exactly stated to avoid any delays in the funds clearino with our bankers. The oavment is to be made by IBAN or as SWIFT teleoraohic transfer within one business day. Please provide First Private Equity Group with a copy of the transfer receipt pending clearance. Once received, a receipt will be sent to you from First Private Equity Group. This receipt will confirm the details, amount paid, and your now account number. Type of Accounts: There are three account levels available at First Private Equity Group. Silver: Min. $100,000.00 deposit. Gold: Min. 5250,000.00 deposit. Platinum: $1,000,000.00 deposit. Please circle the account type that you are applying for. EFTA01125045  1 Account Opening Form — (personal details) Account Owner Second Account Holder (if applicable) Title (please tick) Title (please tick) Mr Mrs Miss Ms Other (please specify) Mr Mrs Miss Ms Other (please specify) Your Last Name Your Last Name ostopaas4 Your First Names Your First Names Nt(cbtal 1 —OKI Mailing Address Mailing Address City City ea10 Sto State State 6401CLOM1) (A) oguutost) Zip Zip 02 -6/(Q Country Country Nors#WAtti Daytime Telephone Number Daytime Telephone Number Evening Telephone Number Evening Telephone Number Email Address Email Address Date of Birth (MM-DD-YYYY) Date of Birth (MM-DD-YYYY) Place of Birth Place of Birth 13S-RA)M 09I0 Marital Status Marital Status IttistecOP MAePC, Number of Dependants Number of Dependants Mothers Maiden Name Tag' LA, (A4Ar5ck) fiANeice1J Mothers Maiden N T7e r e 6, 9 lor CAPPCW4f) RCYCKPM1/- 2 EFTA01125046 Account Owner Second Account Holder (if applicable) Employment Status (please tick) Employment Status (please tick) Employed )( Self Employed Employed >e Self Employed Homemaker Student Homemaker Student Retired Retired Other (please specify) Other (please specify) Start Date With Current Employer (MM-DD-YYYY) Start Date With Current Employer (MM-DD-YYYY) 0 e ( 9 96 (2 0 ! le 0 Employer's Name Employer's Name ARICtiarree-40Pai LtU£ fear/VAS Fgo6Ncr. ACN to tiC Employer's Address Employer's Address r PeA6NEK MONACErer tstoer dc\-“,c gctfAFT3 PC. Z. ZAttLIKAraeic 02-n- CiSt--0 0243- etS(O City City os fr e i OSL-1D State State NOISAA.ber N)01CtotAcr Zip Zip OZeR— Country Country NoietUistit' Employer's Telephone Number Employer's Telephone Number Evening Telephone Number tvening ierepnone Number Occupation Type Qccupation Type ARCIAI CHCVKszNIA armorNugsozi ,r,r Industry Type dustry Type Title / Position Title / Position 'waniruc- ye-ito mASIS( Rrevlous Employers Previous Employers 3 EFTA01125047  1 Account Opening Form - (financial profile) Total Annual Income (please tick) € 0 - € 100.000 E 100.000 - E 250.000 X E 250,000 - E 500,000 E 500,000 - E1000.000 E 1000.000 + Total Household Income € 0 - € 100,000 E 100,000 • E 250,000 E 250,000 - € 500.000 E 500.000 - €1000,000 E 1000,000 + Total Net Worth E0- 100,000 E 100.000 - 250,0001 E 250,000 - 500.000 E 500,000 - €1000.000 € 1000,000 + Are you a director, executive officer, 10% shareholder or someone who has the ability to control corporate action of a public company? (please tick) Yes >e No 1 Account Opening Form — (account profile) Account Objectives (please tick) Income y Growth Total Return Risk Tolerance (please tick) Conservative ) 14/ Moderate Aggressive 4 EFTA01125048 2 Terms of Agreement Client Trading Agreement In consideration of First Private Equity Group (FPEG) accepting the account (the 'Account"). the Client (the "Client") agrees: 1. That this Agreement is in reseed to all Security transactions in the Account of the Client. This Agreement is in respect of all transactions in the Account of the Client, including accounts previously opened. opened in the future or from time to time closed and then reopened or renumbered; that the word "Securities" shall include all Securities generally so-called and in particular shall include equities. bonds, debentures, notes, options. warrants, rights. "When Issued" Securities of all kinds and chooses in action of every kind, and all property customarily dealt in by brokers. 2. That every transaction is subject to the constitution, by-laws, rules, regulations and customs of the Exchange upon which the transaction is executed, and to the customs and regulations (now or hereafter in effect), of the applicable Clearing Corporations including, without limitation, position limits and exercise limits, and if not executed upon any exchange to the by-laws, rules. and regulations and customs of any market association of brokers or dealers made applicable thereto by any law or agreement. 3. That the Client shall pay any and all commissions to FPEG in respect of all purchases and sales of Securities in the Client account. 4. That FPEG operates on a flat one percent (1) commission on both entry and exit trades. Entrance commission will be added to the total amount payable. Receipt of funds that is short of trade value, inclusive of commission, will be deemed to have paid commission but left the remaining portion of the trade unpaid. lithe client executes a sell order through a third party. the exit commission agreed to be paid to FPEG will be deemed to be standing and indebted accordingly. 5. That FPEG shall not be responsible for any delays in bringing the Client's order to market, including delays caused by failure of communication services or equipment or by excess volume of trading. FPEG shall not be responsible for the accuracy of any quotation or market information given to the Client. FPEG shall not be responsible for any loss or damage incurred as a result of a trade made upon the advice of any employee of FPEG or as a result of the cancellation or change of an existing order not reaching the trading point prior to execution of the order to be cancelled or changed. 6. That as part of FPEG's service directive, the account managers of FPEG undertakes to keep the Client informed throughout the process of the trade, keeping the Client abreast of major market movements, and issuing appropriate recommendations when to sell. Ultimate responsibility for the decision to sell is borne by the Client and FPEG will make available specified public and private resources to assist Client preparedness. 7. That for said securities that return a dividend on investment, the company will seek returns and destination of that dividend by remittance to an account of the clients' choice/approval. 8. That upon encashment of any security or cancellation of the clients' account the client at his/her request may have funds directed to an account of choice subject to the client providing all necessary references to execute the request. 9. That FPEG, its and their respective directors, officers or employees may at any time or from time to time have a position in any or all Securities being traded on behalf of FPEG's Client, and that FPEG will, if trading in the same Securities, at the same time as the Client, undertake to accord the Client's order priority in accordance with existing rules and regulations of the exchange or market where the order is being executed. . 10. The Client acknowledges and consents that FPEG is required to report any position that is in violation to the regulatory authorities. 11. That every transaction indicated or referred to by FPEG in any notice, statement, confirmation or other communication, and every statement of account shall be deemed and treated as authorized and correct and as ratified and confirmed by the Client unless FPEG shall actually receive at FPEG's Head Office written notice to the contrary within forty-five (45) days from the time such notice, statement, confirmation or other communication was sent by FPEG to the Client by mail or through any other method of delivery. Until otherwise instructed in writing, FPEG will send all such documents to the Client at the permanent address of the Client. 5 EFTA01125049 2 Terms of Agreement 12. To undertake to advise FPEG in writing addressed to the Head Office of FPEG in New York City to the attention of the Client Services Manager, of any and all changes to the information appearing on any of the Client's application forms. All written notices and communications sent by FPEG to the Client will be deemed to have been received if sent by mail or any means of prepaid. transmitted or recorded communication or if delivered to the Client, at the permanent address of the Client or as otherwise directed herein. 13. That this Agreement shall ensure to the benefit of FPEG and be binding on them and their successors and assigns and on the Client's successors, executors. administrators. assigns, and legal representatives and shall be interpreted according to the Laws of the country of investment. 14. That all transactions will be quoted in US Dollars. 15. Trades in currencies other than the currency of the account in which the trade is to settle require currency conversion. We act as principal when converting currency for such transactions at rates established or determined by us. This will be taken directly from current market exchange rates. We may earn revenue on the spread between the bid and offer rates for the currency and the rate at which the rate is offset in the market. Any currency conversions will take place on the trade date unless otherwise agreed. 16. That this agreement supersedes all previous agreements between me and First Private Equity Group. 17. That the signature(s) appearing on this form isfare true and official signature(s) of the aforementioned account and may be used for verification of the said account at all times and for all purposes. The personal information supplied to First Private Equity Group is deemed truthful and accurate. 6 EFTA01125050  2 Terms of Agreement Privacy Policy Al FPEG, we understand that the privacy and security of your personal and account information are important to you. FPEG maintains confidentiality standards that are designed to protect your personal information. When you browse the public portions of the FPEG website your account and/or personal information cannot be retrieved from FPEG 's systems. FPEG employee access to customer information is limited to staff that require the relevant information to properly service your account. Our employees are continuously educated on the importance of maintaining the confidentiality of customer information. When we collect information about you, we will explain how we intend to use it. We limit the information collected to what we need for those purposes, and use it only for those purposes. We will give you access to the information we retain about you, and make every reasonable effort information accurate and up-to-date. You can help by keeping us informed of any to keep your changes, such as a new address or telephone number. If you find any errors in our information about you, let us know and, if incorrect, we will correct them. If you require information, simply contact us with specific details of your query. We will advise you in advance if a charge will be required for conducting the search, and we will respond to your request within 7 days. Any personal and account data maintained by FPEG is done to fulfill our legal and regulatory requirements and to provide you with the products and services you request. Save for these exceptions, FPEG will not share, sell or distribute your personal or account information to any outside source. Usually, you can refuse your consent to share information. or withdraw it at any time. by contacting us in writing. We will explain your options and any consequences of refusing or withdrawing your consent. and record your choices. If you donl want us to share information with your referring financial institution, you can tell us any time. Communications with FPEG are secure. FPEG utilizes state-of-the-art Internet security. We will release your information when required Of permitted by law. We must give information in response to a valid demand. search warrant or other legally valid enquiry or order. We may also disclose information to an investigative body in the case of a breach of agreement or contravention of law - this helps prevent fraud, money laundering or other criminal activity. For regulatory purposes, self regulatory organizations require access to personal information of current and former clients, employees, agents, directors, officers and others that has been collected or used by FPEG. SROs collect, use or disclose such personal information obtained from FPEG for regulatory purposes. including: • Surveillance of trading-related activity; • Sales, financial compliance, trade desk review and other regulatory audits; • Investigation of potential regulatory and statutory violations: • Regulatory databases; • Enforcement or disciplinary proceedings; • Reporting to securities regulators; and • Information-sharing with securities regulatory authorities, regulated marketplaces, other SROs and law enforcement agencies in any jurisdiction in connection with any of the foregoing. 7 EFTA01125051  3 Confidentiality Agreement This Confidentiality Agreement entered into by Nee/At AtEcAN -Met (#P ELCA- "The Client; and First Private Equity Group "The Company'. This 73rr day of MA! .2012. WHEREAS. The Company is prepared to make its Confidential Information available for review by persons who may be interested in purchasing securities. but desires to protect its Confidential Information. WHEREAS. The Client is considering purchase of securities and may receive such Confidential connection with a due diligence review of the prospective security. Information in IT IS AGREED: 1. The term 'Confidential Information' shall include any information that derives independent economic value from the fact it is not commonly known by the public. This also includes all written and verbal communicati ons by Company to the Investor, including the fact the Company is seeking to complete any business transaction. 2. Investor acknowledges that this Confidential Information is of value to the Company by providing it with a competitive advantage and is not intended for general dissemination. 3. Upon receipt of any Confidential Information. Investor agrees to prevent its disclosure to any third party, unless expressly authorized by Company. 4. Any violation of Paragraph 3. shall be considered a material breach of this Agreement, and Investor agrees the Company will be entitled to all available civil remedies, including attorney fees and court costs. 5. Investor agrees that the provision of Confidential Information by Company constitutes adequate legal consideration for a valid and binding Agreement. IN WITNESS WHEREOF.: toes CesPreai 61-1,FSEV CLIENT NAME CLIENT ADDRESS 8 EFTA01125052  4 Banking Instructions Beneficiary Banking Details Funding instructions are included in a separate sheet attached herein. REFERENCE INSTRUCTIONS: I. Complete the banking details in accordance with above. 2. Include the invoice number in the memo section of the transfer form. 3. Check - 'Remitter pays all banking fees'. 4. Fax a copy of this invoice and a copy of the transfer receipt to: FAX: +1 5. Confirmation of funds receipt will be forwarded to you immediately when processed. 9 EFTA01125053 Form W-8BEN Certificate of Foreign Status of Beneficial Owner (Rev. December 200(1 for United States Tax Withholding OMB No. 1545.1821 Oupannitni of the beastay e Section references are to the Internal Revenue Code. e See separate Instructions. Internal Rerenue Same e Give this form to the withholding agent or payer. Do not send to the IRS. Do not toe this teem for: Instead. use Form: • A U.S. citizen or other U.S. person, including a resident alien individual W-9 • A person claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States. . . . . . . . . . . /43ECI • A foreign partnership. a foreign simple trust. or a foreign grantor bust (see rnsuuctions for exceptions) W-BECI or W-RIMY • A foreign government. international organization. foreign central bank of issue. foreign lax-exempt organization. foreign private foundation, or government of a U.S. possession that received effectively connected income or that is claiming the applicabilty of sectioMs) 1150. 501(c). 892. 895. or 1443(b) (see instructions) . . • . . . . tftElEa or W.OEXP Note: These entities should use form 141-8BEN if they are claming treaty benehts or are providing the form only to elan they are a faeign person exempt hem backup withholding. • A person acting as an intemedery W.81MY Now: See instructions for additional exceptions. Part I Identification of Beneficial Owner (See instructions.) Name or Incleadual or of nation al Is the beneficial owner 2 Country of incorpxation or 0rgarezatIcii NtIACIAt eavvelCKI 0 3 Type of beneficial owner: eider/dual 0 Corporation 0 Disregarded entity 1. 14 / 3Panii:i si t4j up k t Simple trust CI Grano" tint ❑ convaxiium 0 (state 0 Gcrennmetill 0 intonational agars:atm 0 Cartel bank Cl issue ❑ Tax.exempl onpanateron 0 Private larritialton 4 Permanent residence address (sheet ant. or suite no or rural mute) Do not use a P O box or -careof address. it Qrtown. state or province. Include postal code where appropriate. Country (do MX abbreviate) Cif) 1JentivAt- S Mailing address (If different from above) City or town. stale or province. Include postal code where appropriate Country (do not abbreviate) 6 U.S. taxpayer identification number. il required (see instructions) 7 Foreign tax iiientilying number. if any (optional) ❑ SSN or ITN 0 ON 8 Reference %mere%) (see instructions) Part II Claim of Tax Treaty Benefits (if applicable) 9 1 certify that (check all that apply): it a The beneficial owner is a resident of N wahn the meaning of the income tax treaty between the United States and that country. b U II required. the U.S. taxpayer identification number is stated on line 6 (see instructions). c 0 The beneficial owner is not an individual derives the item (or items) of income for which the treaty benefits are claimed. and. II applicable. meets the requirements of the treaty provision dealing with limitation on benefits (see instructions). d 0 The beneficial owner is not an individual_ is claiming treaty benefits for dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign commotion. and meets qualified resident status (see instructions). • 0 The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707th). and will file Form 8833 it the amount subject to withholdmg received dung a calendar year exceeds, in the aggregate. $500.000. 10 Special rates and conditions (II applicable—see instructions): The beneficial meter is claming the provisions of Article of fits treaty identified on line ga above to claim a % rate of Mlhholding on (specify type of incom0 Explain the reasons the beneficial owner meets the terms of the treaty article: Part II Notional Principal Contracts 11 O I have provided or wiN provide a statement that identifies those notional principal contracts from which the income is not effecezely Connected with the conduct of a trade or business in the United States. I agree to update this statement as required. IEMI Certification Under penalties or penury. I dean that I have examined the mformation on this ram and to the best d my knOwledge art belief t is true. correct. and complete. I runner certify user penalties of perjury that • I am the beneficial ownertr an authorized to sign fa the beneficial owner) or all the income to which this form relates. • The beneficialowner is not n U.S. person. • The income to vetch this form relates is not ellecinenconnected wati ate conduct ol a bade a business ti the United Slates or is effectively connected but rs not subject tout under an Won* lax treaty. and • For btokel transactions a boner exchanges. the benercioi cvmet e an exempt Iceman person as deleted. the eyelet/on> Furthermore. I ailhcni0 the tom to be provided to any withhoiding agent that has control, receipt or onto* of to 'name d whch I an the beneficial owner or any rwthrolding sort they cyg timbale Ake y ymyr. ol the income ce wrath I am the teneetiat Owner 73 •-202 ,- Sign Here Signature of benefice' ow or rithvidual aurnnd to sign kg beneficial owner) Dale IMM.00•WYY/ CaPaclY m which acting For Paperwork Reduction Act Notice, separate inStruCtIonS. Cat. No 250472 Form W-8BEN (Rev. 124003 EFTA01125054