Exhibit 10.3


 


	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if applicable)

  
	
  Credit
  Line Account Application and

  	
  5F

  	
   

  	
   

  
	
  Agreement for Trust and Estate
  Accounts

  	
  SS# / TIN

  	
   

  
	
   

  	
  HT

  	
   

  	
  Internal Use Only

  
					



 


	
  For Internal Use Only

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Variable Credit Line
  Account at UBS Bank USA

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  5V

  	
   

  	
   

  	
   

  	
   

  
	
  Fixed Credit Line
  Account at UBS Bank USA

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  5F

  	
   

  	
   

  	
   

  	
   

  



 


	
  Collateral Account(s) at UBS
  Financial Services Inc.

  	
   

  	
   

  
	
  Insert the information
  below for each UBS Financial Services Inc. account to be pledged to secure
  the Borrower’s credit line.

  
	
  Full Collateral
  (Securities) Account Title

  	
  Branch

  	
  Account Number

  	
  FA#

  
	
    1)

  
	
    2)

  
	
    3)

  
	
    4)

  
	
    5)

  
	
    6)

  
						



 


	
  Credit Line Account

  
	
  Select the type of
  credit line account:

  	
   

  	
  Select
  the type of Borrower:

  
	
  o   Variable
  Credit Line Account

  	
   

  	
  o   Trust

  
	
  o   Fixed
  Credit Line Account

  	
   

  	
  o   Estate

  
	
  o   Both

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  If you do not indicate your
  preference you will be deemed to have selected the “Both” option.

  



 


	
  Borrower Information (Trusts)

  
	
  Complete this section
  only if a Trust account is being opened. Estate accounts should skip to the
  Borrower Information section below.

  
	
   

  	
   

  	
   

  
	
  Trust designation is:

  	
   

  	
   

  
	
  o   UBS Financial Services
  designated TTEE

  	
   

  	
   

  
	
  o   Self - TTEE / UBS
  Financial Services Designated Successor

  	
   

  	
   

  
	
  o   Self - TTEE / Outside
  Successor

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Is there more than one
  Trustee for this account?  o Yes   o No 

  	
   

  	
   

  



 


If yes,
specify how many Trustees:                  ,
then complete the Trustee/Grantor/Executor/Administrator section (pages 2-3)
for each Trustees. If there are additional Trustees please photocopy pages 2
& 3 and submit it with the application.


 


Borrower Information (continued)


Complete this section using the Trust or Estate
information. Please
do not complete this section for the Trustee, Grantor, Executor, or
Administrator Information.
The Trustee/Grantor/Executor/Administrator information must be completed below.


 


	
  Basic
  Information

  	
   

  	
   

  
	
  Trust / Estate Name:

  	
   

  	
  Taxpayer ID #:

  
	
   

  	
   

  	
   

  
	
  Trust was created under:

  	
   

  	
  Address:

  
	
  o   Will, Irrevocable
  (Testamentary)

  	
   

  	
  Street Address (If
  a P.O. Box, complete the Additional Address 

  
	
  o   Irrevocable Trust
  Agreement (Intervivos)

  	
   

  	
  Information on page 4 .):

  
	
  o   Revocable Trust
  Agreement (Intervivos)

  	
   

  	
   

  
	
  Note: A testamentary trust becomes
  effective upon the death of the 

  	
   

  	
   

  
	
  grantor and an intervivos trust is
  created and effective during the 

  	
   

  	
   

  
	
  lifetime of the grantor.

  	
   

  	
  City:

  	
  State:

  	
  ZIP:

  
	
  Date Trust Established:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jurisdiction of Trust/Estate:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o   USA  o   Other:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
									



 


	
  HT Rev 07/08 HT LOAD SPEDOC UX E HT V100

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
  

  	
   

  	
  Sign and date the application on page 5

  



 

















 


	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if applicable)

  
	
   

  	
  5F

  	
   

  	
   

  
	
   

  	
  SS# / TIN

  	
   

  
	
   

  	
   

  	
   

  	
  Internal Use Only

  
					



 


	
  Borrower Financial Information

  	
   

  	
   

  
	
  Annual Income:

  	
   

  	
  Liquid Assets:

  	
   

  	
  Is the Borrower an
  officer or member of the board of directors of 

  
	
   

  	
   

  	
   

  	
   

  	
  UBS AG, its subsidiaries
  or affiliates?*

  
	
  Net Worth

  	
   

  	
   

  	
   

  	
  o  Yes  o  No    If
  yes, please specify:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Subsidiary or
  Affiliate

  	
   

  	
  Employee Name and
  SS#

  
	
  Is
  the trust/estate or any trustee/executor a control person of 

  	
   

  	
   

  
	
  UBS
  AG or its subsidiaries or affiliates? *

  	
   

  	
  Is the trustee/executor
  of the Borrower an immediate family member of an 

  
	
  o  Yes  o  No    If yes, please specify company and %:

  	
   

  	
  executive officer or
  member of the board of directors of UBS AG?

  
	
   

  	
   

  	
   

  	
  %

  	
   

  	
  Immediate family member means a
  spouse or any other relative residing in the 

  
	
   

  	
   

  	
  Borrower’s household to whom
  the Borrower lends financial support.

  
	
  Does the trust/estate
  own 10% or more of the shares of any publicly 

  	
   

  	
  o  Yes  o  No    If
  yes, please specify:

  
	
  traded company?

  	
   

  	
   

  	
   

  	
   

  
	
  o  Yes  o  No    If
  yes, please specify company and %:

  	
   

  	
  Subsidiary or
  Affiliate

  	
   

  	
  Employee Name and
  SS#

  
	
   

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Will any of the loan
  proceeds be used to repay any debt or obligation owed 

  
	
   

  	
   

  	
   

  	
   

  	
  to, or purchase an asset
  from, UBS AG or its subsidiaries or affiliates?

  
	
   

  	
   

  	
   

  	
   

  	
  o  Yes  o  No    If
  yes, please specify:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Subsidiary or
  Affiliate

  
											



 


	
  *For
  purposes of these questions, “control” means a person or entity that either
  (a) owns, controls or has the power to vote 25% or more of any class of
  voting securities, (b) has the ability to control the election of the
  majority of the directors of a company, or (c) has the power to exercise a
  controlling influence over management policies. A person or entity is
  presumed to have control of a company if the person or entity owns, controls
  or has the power to vote 10% or more of any class of voting securities of the
  company and (i) the person is an executive officer or director of the company
  or (ii) no other person has a greater percentage of that class of voting
  securities.



  



 


Trustee/Executor/Administrator Information


Complete
this section for the Trustee of
a trust account, or an Executor or
Administrator of an estate account. To include additional
trustees or executors please photocopy this section and submit it with the
application.


 


	
  The
  information below is for a:

  	
   

  	
  o  Trustee       o Executor/Administrator

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Basic
  Information

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Corporate Trustee Name: (if applicable)

  	
   

  	
  Street Address: (If
  a P.O. Box, complete the Additional Address 

  
	
   

  	
   

  	
  Information on page 4 .)

  
	
  Individual Trustee First Name:

  	
   

  	
  Middle Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Last Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  
	
  Country of Citizenship:

  	
   

  	
  SS#/TIN:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o  USA

  	
  o  Other (specify):

  	
   

  	
   

  	
   

  	
   

  	
  Date of Birth:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Passport/CEDULA and Green Card#: (If non-U.S. and no
  SS# specified)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Residence Telephone Number:

  	
   

  
	
  Passport/CEDULA Country of Issuance:

  	
   

  	
   

  	
   

  	
   

  
																					



 


	
  The
  information below is for a:

  	
   

  	
  o  Trustee       o Executor/Administrator

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Basic
  Information

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Corporate Trustee Name: (if applicable)

  	
   

  	
  Street Address: (If
  a P.O. Box, complete the Additional Address 

  
	
   

  	
   

  	
  Information on page 4 .)

  
	
  Individual Trustee First Name:

  	
   

  	
  Middle Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Last Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  
	
  Country of Citizenship:

  	
  SS#/TIN:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o  USA

  	
  o  Other (specify):

  	
   

  	
   

  	
   

  	
   

  	
  Date of Birth:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Passport/CEDULA and Green Card#: (If non-U.S. and no
  SS# specified)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Residence Telephone Number:

  	
   

  
	
  Passport/CEDULA Country of Issuance:

  	
   

  	
   

  	
   

  	
   

  
																					



 


	
  HT Rev 07/08 HT LOAD SPEDOC UX E HT V100

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
   

  	
   

  	
  Sign and date the application on page 5

  



 


2

















 


Grantor Information


Complete
this section for the Grantor of
a trust account. To include additional grantors, please photocopy this section
and submit it with the application.


 


	
  Basic Information

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Street Address: (If
  a P.O. Box, complete the Additional Address 

  
	
  Individual Grantor First Name:

  	
   

  	
  Middle Name:

  	
   

  	
  Information on page 4 .)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Last Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  
	
  Country of Citizenship:

  	
   

  	
  SS#/TIN:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o  USA

  	
  o  Other (specify):

  	
   

  	
   

  	
   

  	
   

  	
  Date of Birth:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Passport/CEDULA and Green Card#: (If
  non-U.S. and no SS# specified)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Residence Telephone Number:

  	
   

  
	
  Passport/CEDULA Country of Issuance:

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Do
  you derive a substantial amount of your income/wealth  

  
	
   

  	
   

  	
  (over
  50%) from a country outside of the United States?

  
	
   

  	
   

  	
  o  No  o  Yes    If yes, specify:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Country(ies)

  
																				



 


	
   

  	
   

  	
  Street Address: (If
  a P.O. Box, complete the Additional Address 

  
	
  Individual Grantor First Name:

  	
   

  	
  Middle Name:

  	
   

  	
  Information on page 4 .)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Last Name:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  
	
  Country of Citizenship:

  	
   

  	
  SS#/TIN:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o  USA

  	
  o  Other (specify):

  	
   

  	
   

  	
   

  	
   

  	
  Date of Birth:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Passport/CEDULA and Green Card#: (If
  non-U.S. and no SS# specified)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Residence Telephone Number:

  	
   

  
	
  Passport/CEDULA Country of Issuance:

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Do
  you derive a substantial amount of your income/wealth  

  
	
   

  	
   

  	
  (over
  50%) from a country outside of the United States?

  
	
   

  	
   

  	
  o  No  o  Yes    If yes, specify:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Country(ies)

  
														





 





 


	
  Credit
  Line Account Features

  	
   

  	
   

  	
   

  
	
  Check Writing

  	
   

  	
  Alternate Mailing Address for Checks

  
	
  If you would like to
  receive Credit Line checks for your credit line account, please enroll below:

  	
   

  	
  Print the mailing
  address for the delivery of checks if different from the 

  
	
   

  	
  address on the checks:

  
	
   

  	
   

  	
   

  
	
  o   Check here if you
  would like Credit Line checks.

  	
   

  	
   

  
	
  Checks will be in the
  name of the Borrower.

  	
   

  	
   

  
	
  Please print the address
  that you would like to appear on your checks.

  	
   

  	
  Wire
  Instructions for Loan Payment: (In US Dollars) 

  
	
   

  	
   

  	
  Bank
  Name: UBS AG

  
	
   

  	
   

  	
  Wire
  System Address:
  ABA 026007993

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  For
  Further Credit to the Account of: UBS Bank USA 

  
	
   

  	
   

  	
  Account
  Number:
  101-WA-792479-000

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  For the
  Benefit of: Full
  Name 

  
	
   

  	
   

  	
  Account
  Number: 5[F or
  V] 00000

  
						



 


	
  HT Rev 07/08 HT LOAD SPEDOC UX E HT V100

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
   

  	
   

  	
  Sign and date the application on page 5

  



 


3

















 


	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if aaplicable)

  
	
   

  	
  5F

  	
   

  	
   

  
	
   

  	
  SS# / TIN

  	
   

  
	
   

  	
   

  	
   

  	
  Internal Use Only

  
					



 


Senior Political Affiliation


 


Are
you, any authorized signatories, beneficial owners, trustees, powers of
attorney or other individuals with authority to effect transactions, or any of
their immediate family members or close associates a:


 


	
  I)

  	
  Current
  U.S. political official (as defined in section B below)?
               o No
        o Yes; complete:

  



 


	
   

  	
  A)
  Political Official’s Name:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  B)
  Current Position:

  	
  o President

  	
  o Vice President 

  	
  o US Cabinet Member

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  o Speaker of the House
  of Representatives

  	
  o Supreme Court
  Justice

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  o Chairman of the
  Joint Chiefs of Staff

  	
  o Ambassador

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  C)
  Relationship to Client(s):

  	
  o Self 

  	
  o Immediate family
  member 

  	
  o Close associate

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  o Associates with
  business or trust

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  II)

  	
  Current
  or former Senior non-U.S. political official, non-U.S. Religious
  Group/Organization, or Senior/Influential representative of a non-U.S.
  Religious Group/Organization?

  	
  o No   o Yes;  complete: 

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  Political
  Official’s Name:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  Current
  or Former Position:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  Relationship
  to Client(s): 

  	
  o Self 

  	
  o Immediate family
  member

  	
  o Close associate

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  o Associates with
  business or trust

  	
   

  
											





 





 


Duplicate Party Addendum


Complete
this section for each Duplicate Party to receive a duplicate credit line
account statement.


 


	
   

  	
   

  	
  Internal Location Code (UBS Financial Services
  Inc. Use Only)



  
	
  Name:

  	
   

  	
  Country of Citizenship:

  
	
   

  	
   

  	
  o

  	
  USA

  	
  o

  	
  Other (specify):

  	
   

  
	
  Street Address:

  	
   

  	
  City:

  	
  State:

  	
   

  	
  Zip:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Additional Address Information

  If the Borrower’s mailing address is a P.O. Box
  please provide a legal residence address below:

  
	
   

  	
   

  	
   

  
	
  Street Address:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Street Address:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  City:

  	
   

  	
  State:

  	
   

  	
  ZIP:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
															



 


	
  HT Rev 07/08 HT LOAD SPEDOC UX E HT V100

  	
   

  	
  Ó2008 UBS Bank USA. All rights reserved.

  
	
   

  	
   

  	
  Sign and date the application on page 5

  



 


4