Document:

Exhibit 10.2

 

	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if aaplicable)

  
	
  Credit
  Line Account Application and

  	
  5F

  	
   

  	
   

  
	
  Agreement for Organizations and
  Businesses

  	
  SS# /
  TIN

  	
   

  
	
   

  	
  HB

  	
   

  	
  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:

  	
   

  	
   

  
	
  o   Variable Credit Line
  Account

  	
   

  	
   

  
	
  o   Fixed Credit Line
  Account

  	
   

  	
   

  
	
  o   Both

  	
   

  	
   

  
	
   

  	
   

  	
   

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

  

 

	
  Account
  Ownership

  	
   

  	
  Select the
  Organization/Business Structure:

  
	
  Is this entity /
  organization a

  	
   

  	
  o Corporation

  	
   

  	
   

  	
   

  	
   

  
	
  business that provides 

  	
   

  	
  o Corp- Subchapter ‘S’

  	
   

  	
  o Fed Charter-Credit Union

  	
   

  	
  o Fed Charter-Trust Co.

  
	
  commercial goods or
  services (i.e., an operating entity)?

  	
   

  	
  o Limited Liability Company (LLC)

  	
   

  	
  o Foundation-not for profit

  	
   

  	
  o Govt Agency-Federal

  
	
   

  	
  o Limited Liability Partnership (LLP)

  	
   

  	
  o Endowment-not for profit

  	
   

  	
  o Govt Agency-Local Ent

  
	
  o  Yes   o  No

  	
   

  	
  o Limited Liability-Limited

  	
   

  	
  o State Charter-S&L Bank

  	
   

  	
  o Govt Agency-State

  
	
   

  	
   

  	
       Partnership (LLLP)

  	
   

  	
  o State Charter-Savings Bank

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Any
  changes or corrections 

  	
   

  	
  o Sole Proprietorship

  	
   

  	
  o State Charter-Comm Bank

  	
   

  	
   

  
	
  to the
  information on this 

  	
   

  	
  o Partnership-General

  	
   

  	
  o State Charter-Trust Co.

  	
   

  	
   

  
	
  application
  must be initialed by

  	
   

  	
  o Partnership-Limited

  	
   

  	
  o State Charter-Credit Union

  	
   

  	
   

  
	
  you.

  	
   

  	
  o Association

  	
   

  	
  o State Charter-Indus Loan

  	
   

  	
   

  
	
   

  	
   

  	
  o Partnership-Invest Club

  	
   

  	
  o Fed Charter-Savings Assoc

  	
   

  	
   

  
	
   

  	
   

  	
  o Invest Club Membership

  	
   

  	
  o Fed Charter-Nat’l Bank

  	
   

  	
   

  

 

	
  Borrower Information

  
	
  This section should be
  completed by the Organization/Business.

  
	
   

  	
   

  	
   

  
	
  Borrower

  	
   

  	
   

  
	
  Organization
  / Business Name

  	
   

  	
  Location
  of Address

  
	
  Organization/Business
  is (please complete each item that applies):

  	
  o Business - Primary

  	
  o Other (please specify)

  
	
  1)

  	
  o Incorporated

  	
   

  	
  o Unincorporated

  	
   

  
	
  2)

  	
  o For Profit

  	
   

  	
  o Not For Profit

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

  
	
   

  	
  page 3
  .):

  
	
  Industry
  Group (e.g., Construction, Service, etc.):

  	
   

  
							

 

	
  Is the
  Organization/Business publicly listed?

  	
  o No

  	
  o Yes;  specify:

  	
  City:

  	
  State:

  	
   

  	
  ZIP:

  
	
   

  	
   

  	
  Business Telephone Number:

  
	
   

  	
   

  	
   

  	
   

  

 

	
   

  	
   

  	
   

  	
   

  
	
  Exchange (NYSE, AMEX, or
  NASDAQ)

  	
  Ticker Symbol

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Place of Formation /
  Incorporation

  	
   

  	
   

  
	
  o

  	
  USA (if
  formed/incorporated, specify 

  	
   

  	
   

  
	
   

  	
  State):

  	
   

  	
   

  
	
  o

  	
  Other
  (specify)

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  TIN:

  	
  Date of Incorporation / Establishment:

  	
   

  
	
   

  	
   

  	
   

  
									

 

	
  HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
  

  	
   

  	
  Sign and date the application on page 4

  

 

 

	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if aaplicable)

  
	
   

  	
  5F

  	
   

  	
   

  
	
   

  	
  SS# / TIN

  	
   

  
	
   

  	
   

  	
   

  	
  Internal Use Only

  
					

 

	
  Borrower Financial and Ownership 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

  	
   

  	
  Fiscal Year End
  (indicate month)

  	
   

  	
  o  Yes  o  No    If
  yes, please specify:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Subsidiary or
  Affiliate

  	
   

  	
  Employee Name and
  SS#

  
	
  Do you receive a
  substantial amount of your revenue/wealth 

  	
   

  	
   

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

  	
   

  	
  Is the Borrower an
  immediate family member of an executive officer or 

  
	
  o  Yes  o  No    If
  yes specify:

  	
   

  	
  member of the board of
  directors of UBS AG? Immediate family
  member 

  
	
   

  	
   

  	
  means
  a spouse or any other relative residing in the Borrower’s 

  
	
  Country(ies):

  	
   

  	
  household
  to whom the Borrower lends financial support.

  
	
   

  	
   

  	
  o  Yes  o  No    If
  yes, please specify:

  
	
  Does the Borrower own
  10% or more of the shares of any publicly 

  	
   

  	
   

  	
   

  	
   

  
	
  traded company?

  	
   

  	
   

  	
   

  	
  Subsidiary or
  Affiliate

  	
   

  	
  Employee Name and
  SS#

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

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  %

  	
   

  	
  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:

  
	
  Are any of the
  Borrowers, business owners or directors/principal 

  	
   

  	
   

  
	
  officers a control
  person of UBS AG or its subsidiaries or affiliates?*

  	
   

  	
  Subsidiary or
  Affiliate

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

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  %

  	
   

  	
   

  

 

	
  *For
  purposes 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.

  

 

Principal Officer/Beneficial Owner

 

Complete
this section for the Principal Officer(s) of the borrower, or beneficial
owner for an LLC. To include additional principal officers please photocopy
this page and submit it with the application.

 

	
  Principal Officer Name

  	
  SS#

  	
   

  	
   

  	
  Principal Officer Name

  	
  SS#

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Country of Citizenship:

  	
   

  	
  Date of Birth

  	
   

  	
  Country of Citizenship:

  	
   

  	
  Date of Birth

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o   USA

  	
  o   

  	
  Other (specify)

  	
   

  	
  o   USA

  	
  o   

  	
  Other (specify)

  
									

 

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

  	
   

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

  
	
   

  	
  /

  	
   

  	
   

  	
   

  	
  /

  	
   

  
							

 

	
  Passport/CEDULA Country
  of Issuance:

  	
   

  	
  Passport/CEDULA Country
  of Issuance:

  
	
   

  	
   

  	
   

  
	
  Street Address:

  	
   

  	
  Street Address:

  
	
   

  	
   

  	
   

  
	
  City:

  	
  State:

  	
  ZIP

  	
   

  	
  City:

  	
  State:

  	
  ZIP

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Telephone Number:

  	
   

  	
   

  	
  Telephone Number:

  	
   

  

 

	
  HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
   

  	
   

  	
  Sign and date the application on page 4

  

 

2

 

	
  

  	
  UBS Bank
  USA

  
	
  Variable
  Credit Line Account Number: (if applicable)

  
	
  5V

  	
   

  	
   

  
	
  Fixed Credit
  Line Account Number: (if aaplicable)

  
	
   

  	
  5F

  	
   

  	
   

  
	
   

  	
  SS# / TIN

  	
   

  
	
  Credit
  Line Account Features

  	
   

  	
   

  	
  Internal Use Only

  
	
  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

  
							

 

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 your mailing address is a P.O. Box please
  provide a residential street address below:

  
	
   

  	
   

  	
   

  
	
  First Name:

  	
   

  	
  Last Name:

  	
   

  	
  Street Address:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Location of Address:

  	
   

  	
   

  	
   

  	
   

  
	
  o     Business - Primary

  	
   

  	
   

  	
   

  	
   

  
	
  o     Business - Secondary

  	
   

  	
   

  	
   

  	
  City:

  	
  State:

  	
   

  	
  ZIP:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  o     Other (specify) 

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
													

 

	
  HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

  	
   

  	
  Ó 2008 UBS Bank USA. All rights reserved.

  
	
   

  	
   

  	
  Sign and date the application on page 4

  

 

3Exhibit 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

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