4tUBS UBS Financial Services Inc.
Account Number
Client Id
Fund Investment Application Cover Sheet
ATLAS ENHANCED FUND LP
Fund Name
Ghldalne Maxwell
Account title
Ghlslalrie MarweN
Client Name
ACU6
Form
EF2366SS
Control Number
Application id
ECS-0114989654
lentiffhRERVII
ECS-Ol 14989654
O200s U13.5 'Mandel Services Inc. Al Rights Reserved. Member SPC
For Internal the 00y
SDNY_GM_00020437
CONFIDENTIAL
EFTA_00 I 31057
EFTA01273265
•
B•A•• m••
SAL vASNV ASSFT MANAGEMENT , fr
Atlas Enhanced Fund, L.P.
Investor Application Form
Investor(s)
Please:
• Complete the Investor Application Form and return this entire
Subscription Booklet to
your Financial Advisor.
• Only fully completed Subscription Booklets (no faxes, no copies) will be
accepted.
• DO NOT TEAR OUT PAGES.
• Retain a copy for your files.
• Read the Fund's Memorandum and the Subscription Agreement.
Be sure to complete all sections of the Investor Application Form
Financial Advisors/Branch Managers
• Please refer to the Fund Investment Application ('FIA') QuickCard for
application submission instructions, or call UBS Alternative Investments US
at 888-962-3842, option 1, sub option 4.
• Effective July 1, 2014, FATCA compliant W-9s and W-8BENs are required for clients to execute
new investments in all Alternative Investments. Please refer to the enclosed Tax Forms and
related submission instructions.
• All Investor Applications must be submitted on FIA to UBS Alternative Investments US
no later than 6 full business days prior to month's end.
Private and Confidontial
SDNY_GM_00020438
CONFIDENTIAL
EFTA_00B1058
EFTA01273266
Instructions for Completing Investor Application
Prospective investors in the Atlas Enhanced Fund, LP. (the 'Fund•) should read the Memorandum as well
as this
Subscription Booklet prior to subscribing.
Please complete all sections of the Investor Application Form. If you invest via this Subscription Booklet
promptly return the entire Subscription Booklet to your Financial Advisor. Do not tear out any pages. Retain please
a copy
for your files.
Please refer to Schedule 2 for the meanings of the capitalized terms used herein.
Please consult your Financial Advisor or call UBS Alternative Investments US for assistance in completing
this Investor Application Form.
A. Capital Contribution Amount
• Indicate the Capital Contribution applied for (which may be accepted in whole or in part by the Fund).
• Provide your Account Number.
• Funds must be drawn on an account that corresponds exactly to the name of Undersigned.
The Fund may in its sole and absolute discretion accept as your Capital Contribution an amount less
than the Capital Contribution applied for herein.
CLEARED FUNDS MUST BE IN YOUR ACCOUNT 5 BUSINESS DAYS BEFORE 5 P.M. NEW YORK
TIME
PRIOR TO MONTH'S END.
B. Investor Information:
• Provide the Investor's mailing address exactly as it should appear on the address labels.
• include the Investor's state of residence or principal place of business, if applicable, and Social Security/fax
ID Number.
• Provide the Investor's email address.
C. Accredited Investor Representation:
Please read Schedule 1 and check the appropriate box. Generally, an 'accredited investor' has a net worth in
excess of S1 million for individuals (together with spouse) or total assets in excess of 5.5 million for entities. To
calculate net worth, exclude the value of your primary residence, and count as a liability any indebtedness
secured by that property M excess of the fair market value of that property. If you incurred the debt on your
property within 60 days of subscribing for this investment and did not use those funds to purchase that house.
you must include the full value of the debt as part of your liabilities.
The Investor must certify that he, she or it is both an accredited investor and a qualified purchaser in order to
invest in the Fund, unless otherwise determined by the Fund and/or Manager.
Private and Confidential
2
SDNY_GM_00020439
CONFIDENTIAL
EFTA_00131059
EFTA01273267
Instructions for Completing Investor Application
(continued)
D. Qualified Purchaser Representation:
Please read Schedule 1 and check the appropriate boxes. Generally, a 'qualified purchaser" must be an
individual or beneficiary of an IRA- or participant.directed plan or family uustientity with at least E5 million in
qualified investments or an entity with at least $25 million in qualified investments. The Undersigned must
certify that he, she or it is both an accredited investor and a qualified purchaser in order to invest in the Fund.
E. Benefit Plan Investor Status:
Please read carefully and check the appropriate box.
F. Controlling Person Status:
Please read carefully and check the appropriate box.
G. Certification Regarding Initial Public Equity Offerings:
Please initial and complete all applicable sections.
H. Government Entity Status:
Please read carefully and check the appropriate box(es).
I. NFA Bylaw 1101 Certification:
Please read carefully and initial the applicable acknowledgement(s).
J. Investor Acknowledgement:
Please read the acknowledgements contained in this section carefully, Initial the applicable acknowledgements
and complete the applicable certification(s).
K. Investor Signatures:
Please sign.
Private and Confidential
3
SDNY_GM_00020440
CONFIDENTIAL
EFTA_00131060
EFTA01273268
Schedule 1
PLEASE REFER TO THE REPRESENTATIONS BELOW Si ORDER TO COMPLETE DIE INVESTOR TYPE, ACCREDITED
INVESTOR AND
QUALIFIED PURCHASER RENtEsENTAilON QUESTIONS OF THE INVESTOR APPUCATION FORM.
ACCREDITED INVESTOR STATUS ANO IV. Corporations, Partnerships, Limited QUALIFIED PURCHASER STATUS
QUALIFIED PURCHASER STATUS Lability Companies and Other Entities
V. Individuals, Joint Tenant and IRAs
The Undersigned must certify that he, she or (a) The Undersigned is a Canoe bon, (as applicable)
it is an accredited investor and a qualified partnership. limited liability company,
purchaser based on the categories listed Massachusetts a similar business bust, or The Undersigned is a qualified purchaser
below an orgarization described in Section because hershe (atone, or together with
SOfic)(3) of the internal Revenue Code of Winer spouse, if investing jointed owns not
ACCREDITED INVESTOR STATUS less than SS million :n investments • •
1984 as amended (the -Code). rot
I. Individuals, Joint Tenants and IRAs famed for the specific purpose of Setting
VI. 'Family Corporations, 'Family
in the Fund, with total assets in excess of $5
The Undersigned, either ixividualy a Foundations. 'Family Endowments,
milkon; or •Family Partnerships, 'Family Trusts or
together with the Undersigned's spouse, has
a net worths in excess of S I million. fta Each shareholder, partner, or other other 'Family" [Mitts
equity eivner of the Undersigned, as the
N. Trusts case might be, is an accredited investa, a (a) The Undersigned was not formed for
the specific purpose of investing in the
(a) The trust has 6) total assets n excess of (0 The Undersigned is a 'bank' as Fund;
S5 mitron, (I) 4 was not famed for the defined in Section 3(412) of the Securities
specific purpose of nesting in the Lund, Act or a *savings and loan association' or its) The Undersigned owns not less than SS
and (iii) its investment in the Fund is directed other institution referred to in Section milion in nvestments;• • and
by a person who has such knowledge and 3(aX5XA) of the Secunties Act, whether Kt The Undersigned is owned directly or
experience in financial and business matters acting in its individual a f skxary capacity. indrectty by or for 6) two a more natural
that he a she k capable of evaluating the a persons who are (A) related as strings a
ments and risks of an investment in the
(C The Undersigned is a 'broker a spouses (including former spouses), or (8)
fund, a
dealer' ngstered pursuant to Section 15 of direct lineal descendants by birth a
(b) Each Grantor of the trust has the the Secwities Exchange Act, or adoption. (hi spouses of such persons,
power to revoke the trust and regain tide to (n) the estates of such persons a
the trust assets, and each grantor d an fel The Undersigned is an 'insurance M foundations, charitable organzations
accredited investor, or company' as defined in Section 2(a)(13) of trusts established by or for the benefit of
the Sectrities no; or such persons
(0 The trustee of the tn.& is a 'bank' as
defined in Section 3(aX2) of the Securities (0 The Undersigned is an 'irwinvnent VII. Trusts (Other than Truett that
Act a a savings and loan association a company' registered under the Investment qualify under VI or VIII hereof)
other institution referred to in Section Company Act; or
3(aXSXA) of the Securities Act. (a) The Undersigned was not famed for
(g) Tne Undersigned is a 'small business the specific purpose Of investing in the
It Retirement Plans investment company' licensed by the U.S. fund, and
Small Business Administration under Section
(a) The plan has total assets in excess of 55 (301 ) or td) o1 the Small Business (b) The trustee or other authorized person
million; a ewes/men% Act; or making decisions with respect to the trust,
arid each Settler or other penal who has
ite Each participant in the plan is an (Ii) The Undersigned is a 'business contributed assets to the trust, 6 a person
accredited investor; or development company' as defined in described in V. VI, VII or IX
Section 2taX48) of the ineestment Company
(c) The plan is participant directed, with Act a a 'business development company' VIII. Other Entities
investment decisions made solely by persons
defined in Section 202(0(22i of the fal The Undersigned was not loaned For
who are accredited investors; Cr
Investment Advisers Act the specific purpose of Investing in the
OS Investment decisions fee the plan we Note for Accredited Investor Status: Fund; and
made by a 'plan fiduciary' as defined
• The term net worth means total assets (b) the Undersigned is an entity, acting for
Section 3(21) d ERISA that is a bank,
insurance company, registered investment at far market value minus total tabbies. its own account a for the accounts of other
adviser or savings and loan association. To calculate net inorth excfude the fair cNalifkid Purchasers, which in the aggregate
market yaks of your finnan, residence; di) owns and invests on a discretionary basis
count as a Lowey any indebtedness secured not less than 125 milion in investments •'
by that property in eaten of the far market
value of that Property, except that if you
inclined that debl on your properly within
60 days of subscribing for this investment
and did not use those funds to purchase
that house, you most include the full yaks
of the debt as part of your liabilities
Private and Confidential
4
SONY_GM_0002044i
CONFIDENTIAL
EFTA_00131061
EFTA01273269
Schedule 1 (continued)
QUAUFIED PURCHASER STATUS (coard) XII. Investors that checked X(b) or X(c) Control Securities may be included in
IX. Entities that do not qualify under must also respond YES or NO to XII -investments' if (A) the issuer of the
VI•VIR is any direct or indirect beneficial owner of control securities is itself a registered or
the Undersigned itself a Section 3(cX1) or private investment company or is exempted
the Undersigned is a qualified purchaser from the definition of investment company
became each beneficial owner of the XcX7) Company that controls, is conuoded
by, or is under common control with the by Rule 3a-6 or Rule 3a-7 under the
Investor's securities is a %allied purchaser investment Company Act, (B) the Control
as described herein Undersigned? If the Undersigned carton
answer NO to XII because it has a control Securities represent securities of an issuer
Note: relationship suds a beneficial owner that is that lies reports pursuant to Section 13 or
itself a Section Xc)(1) or 3(cX7) Company, ISId) of the Securities Exchange Act. (C) the
Trusts may not rely on rein certification even the Undersigned may be reamed to obtain suer of the Control Securities has a class of
if al of their beneficiaries are qualified securities listed on a designated off -shore
consent from the security holders of such
purchasers. Miner securities market under Regulation S under
the Securities Act or (0) the issuer of the
X. All Investors that an Entities Notes for Qualified Purchaser Status: Control Securities is a private company with
shareholders' equity not less than SSO
(a) The undersigned is not a 3iC)(1) Cr • • fhe term ' investments- means any million determined n accordance with
XcX71Corns>any. or as (1) securities (as defned n the Secuites generally accepted accounting principles, as
Act), except for Control Securities unless reflected in the company's most recent
(b) The Undersigned is a Section 3(c)(1) or otherwise included as described below; financial statements (provided such financial
3(cX7) Company but does not have ANY lutures contracts or options thereon held statements were issued within 16 months of
Prompt,' 30 Holders. or for investment purposes; (31 Physoal the date of Undersigned's purchase of
(c) The Undersigned 4 a Section 31.011.; conwpities held for investment purposes, hieing).
3(c%7) Company arid has obtained consent (4) Swaps and other similar financial
to as treatment as a qualified purchaser contracts entered into for investment NOTE: In determining whether the SS
from all of its Pre-April 30 Holden purpose: (5) real estate held for investment million or SIS million thresholds are met,
proposes, and (6) cash and cash equivalents investments can be valued at cost or fair
XI. Investors that checked VI or VII may held for investment purposes. market value as of a recent date. If
check XI instead oe X investments have been acquired with
indebtedness, the amount of the
The Undersigned has obtained consent to its indebtedness must be deducted in
treatment as a chakfied purchaser ham all determining whether the threshold has been
of its trustees. directors or general partners. met
Private and Confidential
5
SDNY_GM_000204142
CONFIDENTIAL
EFTA 00131062
EFTA01273270
Investor Application Form
A. Capital Contribution Applied for. S
Note. You: account will be debited for your Cap'
tauten plus the Placement Fee of 2% (which may be
circumstances). A Placement Fe* cola be in addition to your waived in limited
Capital Contribution. Please see the Investor Acknow
section for ackfitional information regarding the Placeme ledgement
Subscriptions will only be accepted in U.S. Dollars. nt Fee.
Account a if vuls <wenn, native I
,IM MOIEMP
8. Investor forma •
SSNfpax
State/Country t:11 Phone:
ID twits lanicenser Feimcel Agee of
Anse/
Fax
Date dark
occupauon: ncin I Preis dem nit Terfc.Mnt Pi )ect
Citizenship: taV's Nabonility UM,
Mr. Mrs Me Cv
inveelot
PAtopintakiim A
Nerve (Few
name. coddle
reins min)d.
Last nerve)
Oil- MOTS
MOW" bY
(Wiesen
enneekit
an-am
C. Accredited Investor Representation
C heck ony one boa
By execute's; this Investor Appkation the Undtrogned
certifies that he. the, ce 4 its applicable) has read and understands
thus investor Application indudng, but not limited to. the the inwuttions to
instructions to
invellor" under Regulation 0 *nutty, net worth in excess of SI meloncakulale the net worth lot accredited investas; and (ii) is a 'accreted
milion fa entilieM and has calculated not worth lot ', tendons (together with spouse) or tots assets
as Karim' h trt instructions n this meg*, In excess of SS
APPObsiCri
Mena read Schedule 1 and check one appropriate box brow.
Note that you must be boas an &fledged investor and a quelled
order to invest in the Fund purchaser is
II Investor is an InctiviclueVAAnoini tenant
(with Rights of Survivorship), check here emm
If Investor is a Revocable Trust, check here O (IDa or O (Rhea O elk
If investor is an irrevocable trust,
check here O (RN or 0 lac
II Investor is a Participant-Directed
RelieteMol Plan. (We hero O ab c
II Mentor is Other Retirement Plan,
(here here: O Mao, O (*bar O Oki
If investor it a Corporation. Partnership,
united liablity Company and Other Entity,
O DVS or O IN)b or O (Mc or O OM a O (Me or O frull
check here. *rifling or O (Anh
Private and Confidential
6
CONFIDENTIAL
SDNY_GM_00020443
EFTA_00131063
EFTA01273271
Investor Application Form (continued)
D. Qualified Purchaser Representation:
the Undersigned is a "qualified purchaser' under the Investment Company Act
(generaly. individuals. beneficiaries of (Rtiparticipam-directed
Math. and Emily/Mist entities must own at least SS million or more in qualified irwiturnenis and entities must ova
Qualified Investments) The Undersigned must certify that he, she or it is both an accredited and invest at least S25 million in
the fund Please read Schedule 1 and check the appropriate boxes. inwstoi and a quaked purchaser m order to invest In
trust entities should read careful), the specific -quaified purchaser'
requirements on Schedule 1, &eluding the requirement (for trusts other than truss
relying on certifications in VI and VU) that both the trustee (or
other authorized person making decisions with respect to the trust) and each Senior or other
peon who has contributed assets :o the trust must
own at least S5 million in qualified investments. The Linde signed's execution of this Investor
Application constitutes certification of the
Undersigned's status as a 'qualified purchaser
if Investor Kan individual or
IRA. or ParticipantAirected
Retirement Plan, check here*
IN)
rf Imesta is
*FamPr Corporation
FOunclatiOrk
'Family" Endowment ▪ (V)a. b and c AND 0 Neer 0 OW a 0 (pent 0 (Xl)
'Family" PritrenhipS,
'family" Trusts or Other
EntrlieS, Check hat
It Infester is a Trust (other than
a few that guard-sounder vi or O (Vina and h AND 0 Moor 0 Mb' or 0 Ode or 0 MI)
‘410, check here:
If !month is another type of O (Olga and b AND 0 Maw 0 OW or 0 Mr or 0 the
Entity. check here
If investor is an Entity that does
not quality under VINO!. chock • (0) AND 0 Marc D Pgb• or 0 doe or D go
hem
'Investors that checked /OP nt yew riewaied00ber °Mellow.
or X(c) must also respond °lea YES OR NO MOW
YES or NO to item X.0 0 YES or 0 NO
E. Benefit Plan Investor Status:
Please certify, by checking the alVircinate box below, whether the InvelSor is or wil be described it any of the following categories (1) an
"employee benefit pion" us deleted in Section 3(3) Of EftSA) that is subsea to EILISA: la a 'Man" (as (Jetted
in Section 4975(eXt)
that is sublecl to Section 4975 of the Code or (3) an entity which Is deemed to LW a -benefit plan investor - or so hold "Man asses" of the Code)
Assets Rules by reason Of equity investments in Stith entity by one or more persons described in clause under the Nan
(t) or (2) above. Examples of the foregoing
include. among Other things. 'Keogh' plans, other tax.quafified retirement plant IRAs. (*ruin oiler types of employee
accounts) and entities that are deemed to hold 'plan assets' thereof. benefit Plans (and
Check one' CI YES or 12(NO
F. Controlling Person Status:
Please certify. by checking the appropriate box below, whether the Investor s a sea be descnbed in any 01 the following categories 0 a person
or entity that has discretionary authority or control With respect to the assets of the Fund. Oa a person or entity that provides investment advice
fora fee (director indirect/ with respect to the assets of the hand or 4.) an 'affiliate- of r person or entity described in clause (0 or 60 abate.
For purposes of this representations an -Oriole of a person Of entity includes any person Of emit/ Controlling.
controlled by a undo common
conoOl with the nelson or entity. el iding by reason of hiving the power to exercise a controlling influence over the maned/wren:I Or
Policies of
the person or entity.
Check one. 0 YES or leCIO
Private and Confidential
7
SDNY_GM_00020444
CONFIDENTIAL
EFTA 00131064
EFTA01273272
Investor Application Form (continued)
G. Certification Regarding Initial Public Equity Offerings:
Rule 5130 'Restricted Persons'
3 :44.:.
. .
; The Fund may elect (Mt to invest in new issues even if yore individual account is eigkile for such transactions
• Please initial the appropriate statement The Unckwsigned has initialed those summents below which apps to it or. V
the Ondertigned is a
corporation. partnershm. bus; or other toNy. %Mild) diVy to any person luring a lloneficiallnterest in the Undersigned:
The Wrote. is any of the foltossAng:
(a: A PNRA member him or of broker dealer
•••• • (b) An officer. director, general partner, associate° person or employee of a FINRA member fain o: other Covered Broker Dealer;
(c) An agent daft:mired Broker Dealer if the agent is engaged in the investment banking or securities bullpen
(c0 An immediate Family Member of a person specified in fb) or (c) above.
(a) A finder or other person acting n a fiduciary capacity to a Covered Broker Dealer naming attorneys, accountants and
financial consultants:
- (0 A person who has the authOnly *buy or sell secwilies for a bank. savaOs and loon institution. insurance company.
investrrent company. investment advise[ d Collective Investment Account.
(g) An Immediate Farndy Member Mammon specified In (e)or (0 above who receives horn a provides to such
person Material
Support.
- (h) A person tided for required to be bee/ in Schreckae A or Schedule C to Form 8() IS owning 10%
Deafer; a more of a Coveted Evoker
- 0) A person Hued (or requiwis to be Wert in Schedule 8 or Schedule C a Form BD whose
ownershrP 'Mein' 0 in a person Inked
in fit
0 Apemen that owns deectty a Witettly 10% or mote of a putific reporting company bled (or required to be fisted
)
Schedule A ol Form SO with respect to a Covered Stoke( Deter. Other than a soak <organs that is fisted on a
national
securities exchange.
- (k) A person that owns °erectly a indirectly 25% or more 01 a pubic reporang company that is a person lined in (i) above other
than a pubic company that o lisped on a national secunbes exchange:
(I) An Immediate Family Member of a tenon tested in (hi through (k) above who recesses from or mantles to such person
Material Support;
(m) An account (Inducing a corpormson, partnership. !ended bebsiy company, trust ce other entity) in which any of the persons
referred to in (a) through 0) above has a Banelcial lowest (any person in (al through (m). a •5130 Restricted Person')
The investor is none of the above.
For Entities only If you initialed any of Item (a) through (n) above, you may sill be ebflible to Pertldpate in Thew issues" if you
satisfy one of ter exemptions listed under 'New has Exernpilons• at the beck of the Subscription Agreement
If so, plan specify the exemption nuinber (1 through 10) here (exemption 1(b) is not avallablek
NOTE: Exemptions ere not appliraide for individual ratiminant accounts. individual or joint account, UGIMA or UllIAA Amount;
%ANA are treated as newel persons for this purpose.
Private and Confidential
a
SDNY_DM_00020445
CONFIDENTIAL
EFTA_00131065
EFTA01273273
Investor Application Form (continued)
G. Certification Regarding Initial Public Equity
Offerin gs (eOntd):
i:.sc. 3t : Rule 5131 "Covered Persons"
• ( I) Phase initial belowIl applicable or lithe investor is a
Beneficial Interest in the investor- corporation. partnershP, trust or other entity. which apply to any
person haring
The investor. or any person haling a Beneficial Interest
in the Investor, is 9 an executive officer or *kw of a Pubic
or a Covered Non-Pubk Compary, or 9) a person receiving Company
Material Stewod by an executive office or &actor of
Company er a Covered efor.4119K ComPami(aeW person in (i) a 6). a'5131 Covered Person").
(2) II you initiated statement (1) above, you must name each relevant
Pubk Company andke Covered Non-Pubic Company:
(3) If you Initialed statement (11 above. please initial
the following oily if such appicaSe Pubic Company or Covered NonPublic Compan
y:
(a) is currently a diets rkeWirg Inuesintent Banking Services provided a
member for Investment Barium Services rn the past 12 by ARRA member, or has paid compensation to a MIRA
months;
(0) expects to man a FINRA Member for Investment Banking
Services within the next 3 mondw or
(0 has entered into an express or implied obligation, directly
MIRA member for the performance of future Investment or indireCtly through its erkuthe officers or directors. to retain a
Bening Services.
H you initialed any of items (a) through (c) above,
you may still be eliale to participate in "new issuer If you
exemptions listed under New Issues Exemptions' sad* one of the
at the back of the Subscription Agreement
If so, please specify the exemption number here (exemp
tion 1(a) is not available):
H the Investor has represented that he, she or it is
represents that he, she or it understands that not a "Restricted Person' or a "Covered Person", the
this Investor further
should the account become a 'Restricted Person' or certificate expires after one year and agrees proem* to notify the rood
"Covered Person".
H. Government Entity Status
C) Is the Investor a Government Taws
C) Yes 1/tio
fie if the Investor is acting as agent, reprosentatike or nominee
to one or more investors. is any ol such mveston a Government Entity)
O Yes ti/ No
(ii) If the answer to question GI) is "Yes', please imitate the navies
ol any such investor
Private and Confidential
9
SDNY_GM_00020446
CONFIDENTIAL
EFTA_00131066
EFTA01273274
Investor Application Form (continued)
FIFA Bylaw 1101 Certification (Meese initial es appropriate:,
Individual, IRA. Joint and Foundation Investor=
The biretta represents and warrants that it is an inctodual. IRA or a foundation and that It is
not required to be a
member 01 the National Futures Association rt ,fAl or to be *capered with the Commodity
Futures Trading Commission
("CFTC") n any rapacity. ilelmar comma on to Section A. fewest°, Acknowledgement)
OR
All Other Entity Investors
The Invest°, (or, d the Investor is a commodity pool the opersor thereof) represents and warrants
it n not requred to be
a member of the NM or to be se ts eed with the CFTC in any capacity
(Pleas* note. while not Sways the case, generally, certain private investment vehicle such
as single member
limited lability companies and certain limited partnerships comprised of family members,
among *them,
should initial this section and below if applicable.)
If the Investor is a hand or another investment entity and initialed item (0) above. please compete
the Mowing.
The freesia is a lamay swestrnent vehicle whew participants include only spouses, children,
in-laws,
cousin, or the Investor is a far* dike and has tiled a notice with the CRC under No-Action teller grandparents
12.37
and
The Inrestoi relies upon an exemption from registration under CFTC Rule 4.13 and has
hied a notice darning this
exemption with Ow NFA
The Investor relies upon an exclusion from the definition of the tom 'commodity pool
operator' under CFTC Rule 4.5
and has feed a entitle darning this exemption with the NFA
The Ineettot 6 a nontentrieulny pan, a connibAcey defined benefit plan', a
governmental elan, an employee welfare
benefit plan, or a church plan covered under the Employee Retirement Income Security Act of 1974.
The investor relies upon another exemption or othenvne is not required to
register "nth the CFTC (please indicate below
the applicable ecerresion upon wrath the investa relies or indica* the bass upon which the Investor has determined Mal
tegneation a an exemption is nor required)
OR
Entities that are WA Members and/or those required to register with the CFTC:
(c) The Investor (or, if the Investor is a commodity pool, the operator thereof; represents and variants that it is a member of
the NFA and d registered 'oath the CFTC
Please indicate below the capacity in which the Irritant (or the operator thereof; n registered (commodity pool
operator,
commodity trading advisor, (Munn COmmessicn merchant, nuoduono brakes, a retail foreign exchange dealer:
I With respect to any such plan to with an anwloyee may voluntary". coMfibute, no portion of an employee's rontnbution is committed as margin
:"9,Prenti4O1Cilf DIMAS or options cannons
• Private and Confidential
10
S0NY_GM_00020447
CONFIDENTIAL
EFTA 00131067
EFTA01273275
Investor Application Form (continued)
1. Investor Acknoindedoyment
The Undersigned sruted consult its own U S tat advisor if it is us-rerun es to whether l n a "United
States person" for eirPOWS of U.S. federal
'. income taxation
• ' (a) The Undersigned represent that he, she or it is a -United States person* (as such term is defined in
. •. the Code) for purposes of US. federal income taxation and has provided to U.S a valid and duly
mat mid completed Form W.9, or successor tom thereto, signed under penalties of perjury by
Undersigned. The Undersigned certifies under penalties of perjury that (A) let U.S. such
(diem steam both may be taxpayer
Ittitlited identification number, es it appears in the Investor Application Form In this Subscription
Booklet, is
true and correct and (8) It is NOT subject to backup withholding because either (1) it Is exempt from
backup withholding, (2) it has not been notified by the U.S. Internal Revenue Standee (RV) that It is
subject to backup withholding as a resat of a failure to report all interest or dividends, or (3) the IRS
her notified it that it is no longer subject to backup withholding. The Undersigned will
notify the
Fund within IS days if any of the above certifications are no longer valid. Upon request
by the Fund
or the Manager, the Undersigned shall promptly furnish to the Fund valid and duly completed Form
W-9. or successor form thereto. signed under penalties of perjury by such Undersigned.
The Undersigned has reviewed and confirmed al of the information in the Invester
byes inniat APPlicati0n and confirms
that all of the information that is required to be provided by me Undersigned in this
• • ir per tenants, tanmay be Investor Applcat.on n
mauled to inset true, actuate and complete in all respects
•. •
(C) The UrdeeSigWd represents that he. she or it has received. carefily read and sal be bound by the Agreements. including
arbitration clause whch appears re the Subscription Agreement and the Fund Agreement, and the pre-dispute
agrees that signing below constitutes the
immution and tweet of the Agreements.
(4) The Undersigned represents that he, she or it has received a copy ol
the Memorandum, has reed it end undentloch it, and the Undersigned
is aware of the Fund's 'anted promionS On transferability and withdrawal; he, she or it understands That an investment er the Fond ewcives
conflicts of interest including that tee Placement Agent and its affiliates veil recent payments from the
Imesters. the Fund ancVor their affiliates
based upon the aggregate amount of capital cony/minas to the fund
(e) The Undenigned confirms that the mestment objective and risk profit appficaUe to the investment in this Fund we respectively. 'canter
appreciation' alW 'aggressive • This objective and risk profile is applkable only to this imestment
and may ditto from the investment goats and
risk tolerance for the overall portfolio and the brokerage account in which this orestmenl is held.
(0 The Undersigned understands that an investment in the Fund may impact the Undersigned's future liquidly (eiow, long short-term)
represents thal the undersigned's Investment goats are conistent with the bite frame of pie rwestmem a and
Op The trwestor hereby authorizes (I) the debit of funds. hom the tons account specified herein or sty other account
maintained for the
Subscribe, at UBSFS ('Accounts'). any payments required to be made in connedion with an investment n the fund and
(2) the credit of any
lunch to the Subsater3 Accounts. Including any chsutubonS made by the Fund.
th) The Undersigned understands that the Fund may in its ode and absolute discretion accept as your Capital Cameo:ion an amount ten than
the Capital Contribution applied to herein
zi) The Fund is required pineedically to provide infotmabon to regulators of exchanges oi markets to which it is subject. The
Inimseor
acknowledges thtt UITS Financial Stnices Inc arid its *gents and grimes may receive requests for inhumation from the fund to comply with
Such demands Metcalf for the disclosure of non-public personal information about me that is rotated or unrelated to my investment in the
The Investor acknowledges and agrees that UM Financial Services Inc and its agents and athletes may disclose such non-pubic account
information in 'remit» to such requests The frwestor further acknowledges that the Fund may provide any and al account information relating
to my investment in the Fund to WS Financial SWIM MC and my ORS financial leorkes Inc. financial advisee (current or future)
(j) The investor understands the meaning and legal consequences of the representations. warranties. agreements. cotenants, and contiiMe Van
cat OUI herein and in the Fund's subscription agreement and agrees that the subSCripUon made hereby may tie accepted in reliance Morten. The
In...tot agrees to indemnify and hold numbest U8SFS, including its respective directors. offreit employees and any of its athletes and service
prosaders (collectively, the -Indernrified Party') from and against any and all loss, damage. liability or expense, including costs arid attorneys' fees
and chsbunements, whch the Indemnified Party may incur by reason of, or in connection with any representation a warranty made herein (or in
the accompanying Funds subscription agreement a subscriber information term) not having been true when made, any misrepresentation made
• . by the Subscriber or any lean by the Subscriber to fulfil any of the covenants a agreements set loth herein. Or n the fund's sttaiipoon
• a nt or subscriber information form ot in nether document provided by Me Subscriber to the Fund or any of es Alines
The Undersigned coteries that the Used States is his, her a its country of residence or principal
irtrtul MN; place of business Of undersigned cannot make this overwind,, please talk to your Financial
e pm tenants. own may be mond Advisor about whether you may Incest in the Fund)
to end I
Private and Cenfideridal
11
SDNY_GM_00020448
CONFIDENTIAL
EFTA_001131068
EFTA01273276
1. Ines Acknowledgement (coon)1
The Undersigned acknowledges that a Placental Fee of 2% of the Capital Contribution will be
669 charged if the Undersigned invests through a brokerage account. *avower, in limited
nil Pm tecaws, bath may be traced circumstances the Placement Fee may be waived by the Placement Agent. this Placement Fee is
teinecl
in addition to. and wd not reduce, the Undersigned's Capital Contribution. d the Placement
Fee 6 reduced by agreement between the Placement Agent and the Undersigned, then
the
;educed Placement Fee to Mich Me Undersigned has agreed will be reflected on the ulIS trade
cenfirmaaon The Undenagneo confirms that the Placement Fee has been decinsed with
histherAts Financial Ada arid any additional questions wit be addressed if request& NO
Placement Fee is charged if ten imesiment Is made through a LABS ad.-tatty program.
ON Meese check the appropriate tor below that most accurately describes the Undersigned.
fAn individual mat is a United States Person (inducing his or her trims)
0
An individual that is not a United Sul& Person (including hrs or her ousts)
OA br0ker-dealer
O An InSuraree company
QAn investment company registered with the U.S. Saunas and Exchange Commission
OA 3(c)01 or 3(c%71 Company
QA nonbretht
OA pear plan (excluding a goer nrnental pension Pan)
O A banking or thrift inStitution (proorisitary)
OA state or municipal Government Entity including a governmental nadir
gaol
OA state or municipal governmental pension plan
OA sovereign wealth fund and foreign official institution
O Other (specify)
(n) FOR GRANTOR TRUSTS ONLY q the Undersigned is a grantor trust the Undersigned
acknowledges that any and al grantors of the trust are
S persons for U.S federal income lox purposes (please note grantor Trust with non-U.S. persons
as grantors may not invest n this Rana
(a SCHEDULE K-1 ELECTRONIC DELIVERY CONSENT
Corn*" In BeceinwiTY-ls. Flesitaicales The fund may. in the General Partners discretion. elect to furnish SchedJe K-Is ("K•
is") to Partners electronically Please indKate whether or not the Subscriber
consents to berg furniSted K-Is from the Fund or
rile Administrator electronically if the fund woe to elect to do so @lege initialrap and
• oar met! CalegOry).
I A• tr.: • The Underared consents to being furnished K• Is horn the Randall* Administrator elecUoricady
and not by
hereby acknowledges that it has read and understands the Disclosure Guidelines wt forth below The Subscriber mustmat The Subsea*.
Procedures pronded below for oh consent to be effective blow the Consent
The Undersigned does not consent to being furnished K-Is front the fund a the Adrnmistraux
Pig(c me; furnished It. Is by marl. electronicaly and wants to be
alataeltalladeNIES By Consenting to being furnished K-Is electronically es set lorlh above, K- Is will be lumished to the Sub's-axe electronically
rather than by mad or any oilier means. Nth, Subscriber does not consent to being furnnhed K-Is
elettronicaly. the Fund andlor the Adminrstrata
wal mad paper cosies of the Subscribers K.Is to the Schutt!!
The above consent is for K- Is tor calendar year 2013 and each year thereafter. unless and until the
Subscriber withdraws such consent
Even if the Subscriber has consented to Herclnankally receiving *Is as provided herein, the Ste/sober may request a paper
copy in writing Request
for a paper copy of a KT that has been furnished to the Subscrber electrenially win not be considered withdrawal
a of its cement
The Subscriber can withdraw its consent in writing or by email to investorrelatiornetsmfunds corn Withdrawal wilt be effect*,
upon receipt and roll
be apt:Noble to K-1s that would have been furnished tiectrorecany thereafter. II the Subscnter withdraws its consent.
future K-1s by mall. A unthawed of consent elan not apply to any K-Is that have piteously been the Subscriber will racwe
furnished electronically The Fund will
acknowledge recept of any withitaval of consent in witting a etectionicany, depending on how Such withdrawal of Consent is made
the General Partner may. in its discretion. decide not to &Monica/ furnish K-1s to one Or More limited Partners, in with case
paper copies of
applicable s to such Limited Partners will be mailed. N the Subscriber changes its information on where K-1s are to be turntshed electronic*. the
S, scriber must notify the Fund and the Administrator in writing at the address or e-mail *dans noted vs the above paragraph Similarly. the Fund
6,0 n0tify the Subscriber in writing or Sanwa if how the hind and/or the Administrator wit furnish K.Is electronically changes
To be furnished K. Is electronically, the Sutarter mist have an censer address to which the Fund andor the Admirsoltattt can email K-1s
or
notifications regarding K-1s The Subscribe( may be rewired to print a coot of its K.1 and attach it to its federal. stale or local tax returns
If the Subscriber consents to be hirnished IC-1, electronically, the Fund and/or the Administrator MI send an e-mail to the Subscriber alter each year
when its K.1 is available and the Fund and/or the Adrivnistratee wad serd an email the Subacribee it any of its K. is are amended
consent Prorecketry To consent to being lutrished K- ls by !mail the Subscribe, must e-mal Imesbx Relations at inwestorreletionsatbamfunds.com
stating that it wishes to be furnished K-Is by e-mail. Res will demonstrate that the Subscriber has the ability to receive K• I s by omen and will be able
to recent K-1S sent to the Subscriber by e-rnal in the future.
Private and Confidential
12
SDNY_GM_00020449
CONFIDENTIAL
EFTA_00131069
EFTA01273277
K. Investor Signatures:
Please sign below. Please note that signing below constitutes you:
signature to the Investce Applicator, Fawn. the Subsenotion Agreement and
the Find AgFeement in madame with their term
c> .
GrhSiOitle NIC111•R 11
Pr'''. Wore nn Plane d Aticn$ %wove'
MAKE SURE YOU HAVE COMPLETED AU. APPLICABLE SECTIONS OF THIS INVESTOR
APPUCATION FORM.
Private and Confidential
13
SDNY_GM_00020450
CONFIDENTIAL
EFTA_00 I 31070
EFTA01273278
For Financial Advisors
All "wester Applications must be submittee on FIA to UOS Altemabve Investments US no later than 5 hill busloads
days before 5 gm
New York Time prior to month's end.
I. Investor Suitability and NFA Bylaw 1101:
With legard to the proposed investment of the aforementioned client in the Fund I. at Meng* Advisor to the
chem by signing below, certify that I
have-
(1) informed the client of all pertinent feeIt routing to the lictuidity and Transferabilicy of the fund,
inducing the obligation to maintain sufficient
timidly to meet onooang capital cats (if the Fund has a Capital cat structure; on potentially than notice and that
the n'estment may impart the
Cheats Mule liquidty.
2) reasonable grounds to believe (on the basis of information obtained from the dent concerning the okra age.
insestment experience, income. net mg*, franca situation ar4 needs. Other ', vestments investment objectives.
and any other information known by me. inducing
the attached CAI) that
(a) the Fud being subscribed for is savable and appropriate for the client
(b) the client meets all applicable minimum income, net worth, liquid asset and other objective eatable* standard&
lel me client can reasonably benefit (including realizing any intended tax benefit, if eiape6atee) horn the fund based on the
client's bruncol
position. toenail Immanent objectives and podia° structure.
(o) the client can bear the economic nits of the investment in the fund:
me dienfs goals are consistent with the time frame of the investment and
(1) the ikon appears to have an understanding of
(6 the fundamental rids of the fund (inducing that the dem may lose his or her entire investment/.
(a) the restrictions on the fanicity and transferability or Ow fund.
lei) the background and qualifications of the soon:Or(s) and investment inenargo(s) of the Fund, and
fir) the tin consequences with maid to an enlistment in the Fund;
obtained a valid and duly completed Form W-9 or W-8. as applicable, or successor form Onto. signed wider penalties of
and I have properly placed such form on file purstunt to internal WS POliCy, and perjury by the dent
(a) confirmed, with reasonable due inqury. including may review of relevant account documentation,
the client's repreentations provided in the NFA
Bylaw 1101 Certification fit applicable)
Regarding lion 2(b) abode In the event that the client iS an entity (such as a trust or partnership, that
does not itself meet the nonimen investment
requirements (mob as let worth) I have ascertained Iron the appropriate panes (such as the Clint's trustee or
beneficial owners meet such requirements. general partner) that al of the client's
Vine this investmentputt in the client holding more than 30% of ht net worth as evidenced
on CM nAttematise larestmentss
OYES IINO
t assisted the client in completing any information tat is requited to be proaded by the Cheat in the Investor
ApIdiCalIOn. I
have done so pursuant to the dent's authorization and direction scsagr based upon Mk:Malian that
me by the client t I did not asps( the client in completing any information in the kwestor Application.has been provided to
I certify that I have
reviewed the completed Investor Application form, and I agree that all the information m connection with the Clint's
investment in the fund that is provided by the dent is correct ano actuate.
It. Investor QuallfkatIon foe Offshore Fund offerings only:
I have reviewed the 'Country Qualifications" append to the Memorandum or Subscription Agreement and n any applicable
supplement to the
Memorandum or set forth in the irntruchons on the UBS intranet and I certify that I have reasonable grounds to believe that the dent is
qua/died,
under the law of its country of residence, as described therein. to mad in the Fund Medd:Son. it 6 critical that Financial Advisors review
and
understand the Rules of the Road CROTR-1. with specific locus on alternative rutin:lents, for each country in which the Financial Advisor
expects to
conduct cross border business and hereby confirm that I have reviewed, understand and have complied with the applicable ROTR
It Financial Adasor Servitors Please Sign Below):
Print Name of financial Advnor
Placement Fee aIkintefricirsumnancisi
(mewl.' be charged in addition to Capital Contribution-)
t that accompanies ani's form must be Branco Code6A LoNistco N101 SC.;/ Pb' Ni
11$ anneKanon d signed
Financial Advisors must reconcile the Information listed on this Financial Adviser Telephone
applkation with the clients account records, including updating
the client's net worth. objectives and any caber relevant information. Itnaixial Adesee E Adored
elense nsalte..suce your Branch Manager signs the following page.
Private and Confidential
te
SDNY_GM_00020451
CONFIDENTIAL
EFTA_(() I31071
EFTA01273279
For Branch Managers
IV. Brandt Manager Signature:
locally that I have re/revved the competed bettor Suiutity and Imester QJaldkabons
%MOM above,
CAL and if amicable, the Country QuaNiemen," appendix to the Memorandum a the Subscription the dent InvestOr Application Form and
Agreement and any applicable supplement
thereto or set forth in the instructions on the UBS inUanst. In edition. ills cake; that Financial Advises review and
understand the Rules
of the Road (*ROW), with specific focus on alternative investments, for each county in which the Financial
Advisor expect to coniata
cross border baseless. I agree, based upon the information known tome, with the Financial Advisors determination
that the investment bang
subscribed ford suitable and appropriate Mr the dent and the financial Advisor has rerieVerefi understands
and haS (emptied with the applicable
ROM. I agree that, if the Financial Advise assisted Me client in completing any information that is
required to be provided by the client in the
Investor Application, based upon information known to me that the Financial Advisor has done so pursuant to the ctent's authorization
and
direction scie)y based upon infatuation that has been provided to the Financial Advise by the <Sent
By signing below, if applcable, I have delednned that fn if the proposed investment is for an Access Person's (as defined in
the Investment Maser
Code of Ethics) employee or employee-related motet, my signature evidences ne pre-approver of the trade and
4
Person's proposed investment: a) wit not unrolls emit
proposed investment and (b) does
that (2) the *CCM
*City of eligible clients of U85 financial Senses Inc ('the him') to participate in the
tFPot6eY She lt main
present a material conflict with the inteests of the Firm's <Gents or the Firm.
Print Nene of Branch Manager
Starch Manage Sara tae:WeltatCM Date
qu..91,44 (MUST BE COMPLETED)
If the above named account is a UBS Financial es A, then the Nos: If istructed the CAP Statement that accompanies this form
Ranch Manager, as a result, also signs as the custodian of the IRA musts dared Store or the same day vier appicathsz erred.
and accepts end agrees to this subscription.
PLACEMENT FEE APPROVAL SECTION -THIS SECTION IS ONLY REQUIRED IF A REDUCED PLACEMENT FEE IS CHARGED
to be completed by Complex Director or Complex Admln Manages as Delegate tit necessary)
By signing below you have *greed and accepted the maned Placement In 'bow
in section el
II you do not agree to the reduced placement lee. please inform the bunch vitt is responsible for contacbrg
Al riveter Service Call Al Investor
Services at (888) 962-3842. option I, sub option 4 for questions
Print Name of Complex Director
Complex Director Signature. Date (MUST INE COMPLETED)
Private and Confidential
15
SDNY_GM_00020452
CONFIDENTIAL
EFTA 00131072
EFTA01273280
Subscription Agreement
ADDITIONAL INVESTOR REPRESENTATIONS Mars, WAS wash fees Id alaulson. 'NEW ISSUES* EXEMPTIONS
AND COVENANTS Ihareirolder wan et aciimprt tØ a •
rombaten Sera clopenong an the arranonram bot walkable to errata tamest araOures.
near benaodges rat nas had le U3522 has teeth me Ned party. be the Data thit a astaxal b per accounts. UGAIA a UTMA emcbeS
cope hay to wen Ow atend s Offe2 Staab et/e40/ was may Ores kern one hanti le teem are amid at heel pan kw ros Oaoser
Merroraawn bleemeanab'S al to s bane art if we two NIS en Chirped the lame
reepentem legd mc) tat idea a tenneCten management tee naedo' erttentabalef lee •Je.
rang eat la Beneficial :Meal el mated
enesenwm. afar Se ken the tole 4. %tat an mesa aid pay the sane
manage, odd nor arty Of nee aflame; teondes tee PeratS00e4 imenneese in VW agegale lb% et
amount n her. and In, Inie &Mao in menor cc d the Macey ~ea cee ar teeirkied
mete in OnoteaiOn rya la in fa lee: a beger ansi mar cede ar notelet la kaannal
ad. ta' afal redubtory scareases !indeed n Me each n I -el/watt' ~ad/ It VW 10%
Maas 10 returerma Ands for Kea wery recent it the eapleltOl tast the Ø nee
3.4earandter: be of an ersaelne acre ab. do ra
toga mailerefeaten tenor has conlaced at Proateelit a iefkae no land col etret of all
contra legal tan a segalOry advice and may b fantail Adair win ay gears C nay hate
may net be Meant to Inman perks al inarae0 pars al, apse to row issues a ree
legaing the Catflensaao read by tartan Magee Øw 10%
orariabees Franca ante
tap feskum Menage ~9 ib &Mimes. a meste pen to 690 csanlawaf toy tammon 3S7 The Saki& bona ot 5131
ne Case may he; eased as a placement agreement ciblood la maw by es IMPS Fatal Adtoce Cosa Persons *es to: acted in re /dada
aft Urn I Fa nte Serves Kt.:Ilia/re Ream rating ta Kends ri return hotwascrowig 25% 01 the Urdenigne• er the Cieneldel Mega ef
10
wan 1.656 well nave • ~ad See ter erehao apersed or erased to ye may hewn. aSl 5:31 Care* awes en the ~era mceeds
alb:~ attune %ma Solichabin Man a a Meat unclean& That It is ablated to tease n Me 4WWit 2S% of The ~nand botde
comertart :had from the enalenen Mahar, teary and as emit, new lateen& dry undenatied
- ha implemented proneves redixe
wan may tannhua a n lady of she management the ta Varna ed as nand Pr antelion Wet% Of SI31 Cared Pena
the trauma
tee Gehenna real by the barren' Merager covendited newt and a mantas ofd ry aud with ranee 10 hew tatt n Sse apnea, Eaton
am the fund with react to tum anti Sun me firduting 0~ a aner tax teases) rat are 2S%
rat be payable to UEISFS a it leg as deers droned bang to sun to reamer. and as
sitrauCeP to nap sud by 6856 fat fl an re lance 2 An ~Mal berary manta ender la•
haw a Sterna dwelt, ce naked neared by
~Ment COne)46 An
as hale advise a a wasp& 1.456 vid tenon Kestor Weft That, baba. we Sung or :he
an Kean; lees led rot distrtuari In se de kwestare Manager ander at Adonis:rater may
respect IC ban alas that makt as antere baby a laugh • sow* providete pow* to the 3 A cram an Turd Stat fis maibann fan
Pasoan to an area abeam To :he fl irt attestor tor the aeon% Caboted *Seal IOCC or moat ~vs and tees ratt hall arts: r:
steen(!, KKK ard other achluntateet tie tono ~pally .0 Ina bears ol reseda,
tO/ aptalte ria tallmon. Vis
Enasal Sean. Is 34300ment agent da read; to the espy enact a nears enemata Ø
may rebate al: oi • ;onion d earthNe ote elan a La Fund m falanK fax fa as anti ran
rerrari eldrape la interned a' dean To an Password protected Knot nano on the Fumes • An ~ante r=//pally 0u1ø. tagne Cr
Weary aerial where Me fat FranCee lees sa, n lieu d a n aildmon to andre sten n alment account ptcsded Mt Id ta arose is
bean a compensated a per mama corfnunatial es had ewes et Is a mat Phase %add br panne troy loao n freer 90~/5
&Alba t0 Sun eater ~en: etat pal era :heart are not setta and may CA A a toned account IM innerte teleenial has
bead Mabee viruses re Ott Ogees. Ty na be 1000 or Mye poky dam e"o re twat«
r the Xteestreerc S bead by an smareent urger a
ecarey raft en ono alas. ar ., ay he Correa don not limi one pokyabb wage
U85 away program betweenU95 and the Irate r. irereeded, Oren, at naiad web teteak the bean re toed to Said me 4Øt orredaayli)
tie labor acknovalgen rot I the ante dean Ø0e d the sender or the ~Kid reopent. le« led pray. as d a general data Me
to eel fuch 1,26 acfresCar rmoram the atale De rut* tM (ratetant maned/ re
maT the ~ace many don rot keg . pencyacdcleal
be Meal the saw itialgellent Fee pad by nose Anonstrinas hate no wirranies in read w eire benotate to resented area
united lanes ei t! fund taw at net nepa a s mates the tremor ~Kurds unet tie Fait the
Utt5 &Mao program or Mead au daa reastmen %mar and the awensiralee ere
Sway shane Can and abed ense a naddheSay S A panly tad way den than lassfalee
tM reghl To ',reveal moat arc teten eaeli ea an arPiate oI a trokenderle 'Min such ~-
share dada« may ea in se ealecances 1f0 ~sage .0 and no,. the tams as prone by
odar Crate, The Mate sØØ dear :5 anOreed tO engage a en oink 0tkrirlq
wire far agolicear as If the trale ha ar *cubes atout
let emu on INS Ind orka enders eta rarg el new owes othee as • selling gaup renew a
atherarry of an end puipanedy see by ti trolerwrier: that is listed an a national ~MS
an fitatera in u»lord Fend, the *nested µrage 0 the Anti a& ethane, d rah an ne NAMPO Witaanal Mae
Secaraley. the basso" eknoweetes taw a IØ a ~opt a weal *Smeder:. the new it b • a loner Sue/ vane whines meet re
RaCerara fee of 2% of Inc cab< comanon awn to Oaact the purponad sera ~Ma ciagfain Cana la' In/t9 ca a
arta will oe naiad d the neon ants Inroad, racenta natiOnal ~at/ ~hear ce cm WASOAO Nateral
• ocemage 4~6 area n Vona The abbe ateiremacts Na le balsas re em Maa:
croansteces the Rare' Fee may e Sid by aid may haw to elect 01 reirrug the Yasuo to
the flaterall Agent TIM Mammal Fee is a hY Inn b orar tax wash n aanotchans in 0 An natant Calany Crganaed under he laws
addlienn so. and will not reduce. Ow hasten boa vetch the fcre ce any arsain94Aø is *wad 474 • Omfan Neiman Sawde: the ne drreseneat
conlatan emote ada aleareent feen 'educed the Mena awn ~Oa ettstaget area ~nil Is Idea On a far «hange ør awhaalaed
or agreement between be faecal Agent and the for ri t s te dole by a (oval reoviatory anion,
near. Ian tee rued Olarenseret fee to Meth and Intl /10 person 0Nren0 5 percent at nice Ge the
ese metta ms egad al be mated on the la urmen cameo es • eased pace
rack corftrmater
7 An :Aida benefits den rat 6 dada ace
,' wear tincerstancis and aides tat 1•395 aM
man of a bleats may be mamma Mr Becton arlt cd the Code. 0/0i%/ed dat seede
06"
Meat UISTS bah to aainatme aslant ealanered tot' nya bider clear
andes managed by the eraelena Manage. a et
atlas ate( than Me Surd. :ii aft lees may he A Slate a neleCal averame beat pun that
ewe or den then no lee niaa by ulTS/S and OS o ~algae at minicalcalateen
Valais n CalfiKten tall: the plaemml of beta
in the Idyl deenly, ads ea certain of es 9 A idieseept denude cegandatonuncia Seaton
Wanes an ~pentad los ~ding sienna to 5011c.ileof the Code
*Seteraa armrite enameril
what les. when compunation an indict tabula
&weal les. ensestmeni awry IS A flora an order Sarah asaal d the Code
e mar
enanagerrent ard ban other :ea inauta3
Patehance fee, and df a flue of re Mad
area to Uts6 and its alma corpmes. re ArniMonoy Laundering Tafmnifith•MII•
sant of conartawn 1hel U9S6 ova gene
.MN new 10 the as d aflame et poponary
aria • ream than the ~aunt payee le Ire n Ora to envoy an urea Suds end
aganeasere s a tale Iran the sis or ishavated apeman»: atsi amid al the *Seerman of money
asennenn five la' roof managed by rwd Patty lenrehro ta wifrit !wen each ~or that
n an indadal sentient eat. nnonse win sags,
Private and Confidential
le
SDNY_GM_00020453
CONFIDENTIAL
EF1'A_00B1073
EFTA01273281
to is not. Ms w any Careen or wag cotaang.
conuoted by a tdti <wawa cowl wan re
owed*. a 'Probated gear :a ;arson ached in
chatty :alanderthg a Went aCbreeS, triaging
*ow *Paw a /Mans eat are included at any
relevant led maintaseed Ity the U.S Trnsta
Offslieem °flee of Fabian Assets Cate* ragy
Senor nnatSel PclifX4 hates, their wrinvate Canny
menten and dose assonates. and any roar art
bail War, each wavy tat 6 an entity
farriewis that. among Cialsr owns. td rl has caned
oat thene41 due dame to aura the manes
01 it IWYWKW Maths. (,G a reasor4bly beano that
ro berefttel comer d a Vinnated Fallen* . Oa
rats tre enlace of such airbuses and cat ano
*4 mania Pa% sasienatal tor at east !we yeas
from the now of its <away vmhdrawa from re
had aro fie it swim*. walla such nlownnen
and any addtaal adardoon that the Turd andt:
pe AdmeinAraler may nalae upon Tema that 6
Vesseed rOpkable (equation
(ac' of the rand and tee ikermaintIOr resents re
right tc knit.eit lsKh Toth* ofonr.ata% as t
consam necessary to reify the gentry of a ~eta
ander en Sewee at fun& In Shit fern a aney
lease by the wax to produce any Inkansallas
regusliC Ice tenercaeon *masa ant fital allot Cle
Adineennlor may refute to accept ,a Mall n tne
case of de Admniurated an aeohlalia" pate
acirnalion has been pronad al any film
teemed wl be inumed without traits* le the
accamt Iran vach to manors way airily
&bred
VS (Canal iliceanbasS and an/Cully/ at*"
adenriStered by re V.S. Treaty Dept/felts Office
of reser Assets Central I 'OFAC pat% elste9
at :ling: the warrant in VarlfaCta6 wits
and Me grouch of Inas to, Oda natal 5.
caste. teentown. 'menet and masoclas to as
of OFAC ofdada manes. tenteta. texas and
abuts an be bald an the OFAC wee Ote al
—ONs gOWOCK far InveSICC fetireSenn end
warrants that, among oar ening, are of ess
✓wesa. ant Mesa conuoing, concrolled by a
iandef Lorrirroi coranl with on orKeSlar. are P110,
n erne • anacia intern. in thit 'nester a a/
person C *sem the neva 6 *lag at agent a
Forme. * corewoon with C watmart in re
tuna a a CesnIcy. ltntwy, pecan or Minty naffed en
an COAC Sista 6 a perste a enoty pal fawn a has
&place of business in a Manny or away awed on
sad% list la rano we, not wadi Wy More"
nom a PIOSIXWat mace a re cannel make the
reptelardatien elearibeci et the ofeadie4 wawa
Ya additcn to OIAC tandems, emestofs act tamed
tanners are gnawed le grader inloimao and
docsarnatert niquelatd by Ow fund lee Cannel
Paravr a use turn twat* le ere/ sobs I S
a4S-
roney asuoleting revs and Cr:gunboat als was as.
beatify. towpath laws and ntgelmons w afar
lunaktiOnS Tars bort...0mM; dna 04 the law. al
M rub extent or ant dockateS %hills may be
respired (enrol to dredcard Sy Way a *ant*. It.
Rona and Mt AdernSeant Were Pie flint to
mews' such inlerrnatien a 6 naeSSaly testify Ow
ittenity of a Anita and in bigot of funds
Private and Confidential
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Fran W-9
(Rev. sett 20I 3)
Request for Taxpayer Give Form to the
requester. Do not
DeverInhere of te Treasury Identification Number and Certification send to the IRS.
Inn Reese Sena
Name las shown on vat aflame lax fetia
GhIsSalne Maxwell
Business rernehlorsewded miry nonce deferent horn tore
Check imprOcrktne box kr federal to classilkatiorc EsemptionS bee inauctionia
Inclincluarsow pomace 0 C Cameroon 0 SCormatIon 0 Pertherehlo 0 Trust/estate
trot payee company)
O omensItaly company. Enter the tat ciesedcasen C=C caponttion SvS corpordon.
OsoennerthaPIfi. Fairmont+ from MICA mooting
code SI awl
O Olive (see Instruolkins)•
ass tamer roma wa . a Suite no./
RelueVers vane and widen (C0teall)
Ley. VS. anSZPTiade
New VP* , NY 10065
Ual aeCounl turrterN) tare beta*
Taxpayer Identification Number (TIN)
Eder your TIN in the aopropnate bar. The TIN provided must match the name given On the Name line Social security number
to avid backup ernhholding. Fa indvidualS. this is your social security number
(SSW However. lot a
resident Wien. sole proprietor. a disregarded entry, see the Part I nate:Odle on page 3. For other
entities. It is your employs identilIcabOrt number (OK e you do not
TIN on page 3. have a rumba. see How to eel a
Note. If the account Is in more than one name see the chart on page 4 kw guidelines on whose I Employs identitmellon number
number to enter.
on - Certification
Under penalties of perjury. I only thee
1. The number *hamon die form is my correct taxpayer Wentillcation number Whim
waiting for a number to be issued to me). and
2. I am not subject to badwp Wehholditg beta ism fin) arn exempt horn bedded
witheoldthA a (h) I have not been notified by the internal Revenue
Service (IPS) that I am subject to backup withholding &Serino's of a Mitre to report ea irenn Or tevidends,
a (C) the IRS has notified me that I am
no Mir" subject to backup withh*fing. and
3. I am a U.S. citizen a other U.S. pow Weaned beicra). and
4. The FATCA code(*) entered on this form 61any) exec/rang that I am exempt from FATCA
mooning is correct.
Cadre:Leon Instructions. You must cross out item 2 save If you have been notited by the RS that you we Currently
because you have faded to r subject to backuP wfihttoltfincl
end dividends on your la return. For reel estate transactions. nem 2 does not apply.For malgage
infixed paid. aCQUetnil Of Stewed PrOCottY. Cancelation at debt. contributions to an individual retirenuire arrangement (IM, end
genoulty. payments other and ds4dencle, you we • rewired to sign the certification. but you must provide your correct TIN. See the
dructions en page
Dote •
neral Instructions wthenktho tax on Iona* pours' shay of fl edre* o0Meaed moony. and
Swoon Marna we tote MemelRevenue Code vast °Meade noted 4. Cagy that FATCA coastal entered on to farm a any, Irdcatins that you an
mew° from the FATCA repatag. is cared.
Future developments The IRS has created • Pace on 10.5 gar ix otonsams
about corm W.6, at wiarrecgovrw9. InfonnetiOn tan any Mae demi:roman Nola ft sou am aU.S. parson wid a requester gives you a farm titer eat Fonn
allecfrg Form WA ouch es leglidalon emoted after we releue it) vie to posted W-0 b mama your 11N. you Mal lie Me requersters form if a tn sonnenbaly
on that sway pills to this Form WA.
Delinalon or a U.S. person. For federal lar Disposes. you ere COnsidefod a U S.
Purpose of Form Wan n you arc
A pram who es requkred 10 IS an Intention roam Mei the IRS east coin your • An idivacil tap a it U.S often a US. rowers aren.
correct tsatiterer idenlecallon number OW to meow lot was. Income pad to ▪ A rm.*. corPorwiers COmPaW. a ataciaton crewed a agaraid n the
you. payments made to you n seamen ot owned cad met Vint party network USW Stara a under re lava a the tinted States
tram/venom reel plata transactions. malgage interest YOu pad ealueleltin a
slandonmmt et secured property. onceiestion a debt. a contribution, you made • An estate (Other than a feign estate). a
loan IRA. • A *amnia trial (as definer) In FteguleflOns section 301.770t.i),
Use Peen W.9 only it you we • US. pence ercksang a resident Mere. to Special Mee for partmesleps. Partnerships that caoxt a trade or animas in
evade your correct TIN 10 the mason resetting it tee requested and. when Ow Wiled Sales we gerenay reqtawd to pay a withhold% ter wider melon
applkaele. lo? 1446 on sly tertian partnere awe or eNticlively connected taxable Mean from
1. Cerny and the TIN you as Pane y cowed for you wenen° bra number such buena. Foils. a Certain Cases where& Form WA has not been Waved,
10 be earwig. the nen uncle >41COOn 1448 name a partnership to praetor* t -a owes le a
lodge person and pay art smilen 1446 wmnokling In. Therefore. If you ere •
2. Orly that yea we net stated to backup wateteng. U.S. pasta urn is a Saralee in a partnership ccedtoins a vide or business in the
a. Cr exempren torn backup wehholofing11you we a U.S. exempt payee, if dried Sues. provide Form WiSI to Me partnermo p irslatien your US. status
aortal*. you are Si Certifying that ass a U.S. person your allocates share el and sold totem 1446 wahholang on your Shoo of pennersho (Kam,.
any AWMeratep aware from a US. trade a business a na sited 10 the
CS. No. 10231X FornW-9 jaw Caws)
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