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Employed El Sell-Employed [3 Student O Relined O Self-Supported E Volunteer O Unemployed fl Work in the Home Occupation Busness Phone (optional) Business Fax (optional) Employer Name Industry (re., Construction, Service, etc) (optional) Address line 1 Address Line 2 City AC-MZ (Rev. 12/14) CONFIDENT
r a registered associated person at UBS D0M e Agent First Name Middle Name Last Name Country of Citizenship USA O Other (specify) Passport/Cedula: SSN -.ESnef Address Line 1 City Address Line 2 United States of America State/Province Zip/Postal Code Country Home phone Agent's Relati
Employed LI Self.Employed C Student 9 Retired 5 Self•Supponed 5 Volunteer 9 Unemployed C Work in the Home Occupation Busmen Phone (00henal) Business Fax (oPtiOnal) Employer Name kit uStry Ice, Construction. setvice. etcl (optional) Address Line 1 Address Line 2 City AC•M2 )Rev 12/14) State/Prov
r a registered associated person at UBS K-ESnete It Agent Mai Middle Name last Name Country of Citizenship USA K Other (specify) Passpoil/Cedula SSN Address Line 1 City Address line 2 United States of America State/Province Zip/Postal Code Country Home phone Agent's Relationship. If
K Self-Supported K Volunteer K Unemployed K Work in the Home Occupation Emplo r Name Addr City AC-M7. (Rev. 12/14) Business Phone (optional) Business Fax (optional) Industry (i.e.. Construction, Service, etc) (optional) Stale/Province Zip/Postai Code Country O2014 UBS Financial Services Inc All ig
al Advisor or a registered associated person at UBS Agent First Name Middle Name Country of Citizenship, Z USA K Other. (specify) Passport/Cedula SSN ess tine 2 United States of America City Staternovince Zip/Postal Code Country Home phone Agent's Retationship, If Any, to Principal
Entities connected to both Business Fax and Cedula

UBS AG
ORGANIZATION
Samantha Power
PERSONConstruction, Service
ORGANIZATIONPWM Office
ORGANIZATIONBusiness Service Account
ORGANIZATION
Ghislaine Maxwell
PERSONthe State of New York
LOCATIONUBS Investment Advisory
ORGANIZATIONErnst & Young
ORGANIZATIONUBS Enrollment
ORGANIZATIONUBS Financial Advisors
ORGANIZATION