Trust Signature Page¶
All trustees must sign this document.¶
By signing below, I acknowledge that I understand and agree with the terms and conditions of the UBS Client Relationship Agreement, the Agreements and Disclosures booklet and addendum, and if applicable, the Agreements and Disclosures for IRAs, and the Retirement Plan Disclosures available at www.ubs.com/retirementplandisclosures that is enclosed or that I have previously received. I agree that the representations in these documents are accurate and that I will be bound by the terms and conditions in these documents.¶
Trustee Certification¶
By signing below, I represent that I have reviewed the Trust Agreement and any other documents governing the trust. As trustee, I have full power under the Trust Agreement to make this Trust Certification and have consulted with my legal counsel, if necessary.¶
Investment and Other Powers and Restrictions We represent and warrant that, except as indicated below, we have broad investment and other powers under the trust agreement and applicable law to enter into transactions and to trade, buy, sell, sell short or otherwise acquire, receive, deliver, assign, endorse for transfer, hold or dispose of all manner of securities, futures, currencies and commodities (including options or warrants on securities, futures, currencies or commodities) or to purchase and surrender insurance policies and annuity contracts or interests in any of the foregoing in whatever form they may take, and whether by direct ownership or by interests in funds, partnerships, pools or other forms of collective ownership, except the types of investments specifically listed below:¶
Loans and Other Credit Transactions We represent and warrant that we have broad powers under the trust agreement and applicable law to engage in borrowing and other loan and credit transactions with or through UBS for investment and non-investment purposes, including margin loans, other loans, pledges, mortgages, hypothecations, repurchase and reverse repurchase transactions, letters of credit, credit facilities, and guarantees of the obligations of third parties to UBS (in each case, with no limitations as to amount). We have the authority to pledge, mortgage, assign or subject to a security interest or lien in favor of UBS any property of any sort of the trust as security for any liability of the trust or third parties (in each case, with no limitations as to amount). We have the authority to execute any and all relevant documents and bind the trust in respect of any agreements entered into pursuant to this paragraph, except the types of borrowing or other loan or credit transactions listed below:¶
If the trust has multiple trustees or officers, can one trustee or officer act independently? yes No¶
If No, specify the number of signatures required: ___ (specify number or * all)*¶
If trustees do not have authority to hire an investment advisor or other third party, check here ___.¶
The person identified below is authorized to act as a successor trustee in the event of the death, resignation or removal of all of the current trustees:¶
Name: ___ Title: ___¶
Address: ___¶
Margin Agreement¶
I agree that the Margin Agreement in the Client Relationship Agreement applies to all of my margin-eligible accounts opened now or in the future. This means that if I use margin privileges, UBS will hold the securities in the margined accounts as collateral against the amounts borrowed. I agree to keep sufficient positions in margined accounts to meet any margin calls UBS may issue. I also understand that securities in any margined account may be loaned to UBS or other persons or entities as described in the Margin Agreement.¶
I understand that the Margin Agreement is not applicable to retirement accounts or any other accounts that are not eligible for margin privileges at UBS (including IRAs, ERISA plans, Coverdell Education Savings Accounts, 403(b)(7) Accounts, UGMA/UTMA, Estate or 529 Accounts).¶
Electronic Delivery Consent¶
As requested, I received my Agreements and Disclosures booklet and other account-related documents electronically at jroberts@nutter.com which is the e-mail address of record for all owners of these accounts. I understand that the information is also available at www.ubs.com/accountdisclosures or by request to my Financial Advisor at¶
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EFTA00089254¶
Montpelier Trust¶
For Trust Accounts: Y1 45170 Y1 45172 Y1 45171¶
Check here if you have been notified by the IRS that you are subject to backup withholding, and therefore have crossed out paragraph 2 in the Certification below.¶
Exempt Payee Code (if any) ___¶
If your organization is tax exempt please enter the appropriate code (codes 1 through 13 in the W9 instructions)¶
Exemption from FATCA reporting code (if any):___¶
W-9 Form 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 and 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 in the instructions), and (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.¶
Certification Instruction: You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.¶
The Client Relationship Agreement contains a pre-dispute arbitration clause located in the final section under the title “Arbitration.”¶
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.¶
155 Seaport Boulevard¶
ATTN: Nutter McClennen & Fish¶
LLP¶
Boston, MA 02210-2698¶
Boston, MA 02210-2698¶
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| EFTA00089255 | | :--- | :--- |¶
This is a simple Markdown document with no headings or paragraphs. It contains just one line of text.¶
Montpeller Trust¶
For Trust Accounts: Y1 45170 Y1 45172 Y1 45171¶
Check here if you have been notified by the IRS that you are subject to backup withholding, and therefore have crossed out paragraph 2 in the Certification below.¶
Exempt Payee Code (if any) ___¶
If your organization is tax exempt please enter the appropriate code¶
(codes 1 through 13 in the W9 instructions)¶
Exemption from FATCA reporting code (if any):___¶
W-9 Form 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 and 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 in the instructions), and (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.¶
Certification Instruction: You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.¶
The Client Relationship Agreement contains a pre-dispute arbitration clause located in the final section under the title “Arbitration.”¶
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.¶
Address of Record¶
Address of Record¶
155 Seaport Boulevard¶
ATTN: Nutter McClennen & Fish LLP¶
Boston, MA 02210-2698¶
Email Address of Record¶
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