Investment Account Application and Client Agreement

Transcription

1 FOR INTERNAL USE ONLY ACCOUNT NUMBER: ACCOUNT TITLE: REVISED: SEPTEMBER 2014 PLEASE COMPLETE, SIGN AND RETURN THIS APPLICATION TO YOUR ADVISOR, WHO WILL INFORM YOU OF ANY FURTHER REQUIREMENTS. I. Account Information Individual/joint Partnership Corporation Time Horizon: Less than 1 year PHC/ PIC Sole proprietor Other (Specify): 1 to 10 years More than 10 years Liquidity Needs: (% of principal to fund current year spending needs) 0% 1 25% 26 50% over 50% Risk Tolerance Low Moderate Aggressive Speculative Funding Method: Check Wire Transfer ACAT Internal Transfer* Other* *Account number for internal transfer or details for other method: Investment Objective (identify one): Current Income Preservation of capital with a primary consideration on current income Balanced A balance between capital appreciation and current income with the primary consideration being current income Growth & Income A balance between capital appreciation and current income with the primary consideration being capital appreciation Growth Capital appreciation through quality equity investments and little or no income Maximum Growth Maximum capital appreciation with higher risk and little to no income Speculation Maximum total return involving a higher degree of risk through investment in a broad spectrum of securities Special notes on account handling: Primary Account Owner Name (Print Name): SS# or Tax ID: of Birth: Place of birth: Citizenship: U.S. U.S. Permanent Resident Alien(green card) Non-U.S./Country of Citizenship: Other countries of citizenships: Marital Status (Check One): Single Domestic Partner Divorced Widowed Married If married, spouse s Citizenship: Spouse s other country of citizenship: Home phone: Business phone: Mobile: Primary: address: Alt address: Permanent Legal Address for this Account (For Individual or Entity) Check here if permanent legal address is same as mailing address Check here if all account owners share this address Street Address: Mailing Address for this account (if in US, complete Acknowledgment of US Mailing Address form) Check here if all account owners share this address Street address: Selection of security feature Mobile CAD Physical CAD Mobile No: Model No:

2 2. 2. Additional Account Owner Name (Print Name): SS# or Tax ID: of Birth: Place of birth: Citizenship: U.S. U.S. Permanent Resident Alien(green card) Non-U.S./Country of Citizenship: Other countries of citizenships: Marital Status (Check One): Single Domestic Partner Divorced Widowed Married If married, spouse s Citizenship: Spouse s other country of citizenship: Home phone: Business phone: Mobile: Primary: address: Alt address: Permanent Legal Address for this Account (For Individual or Entity) Check here if permanent legal address is same as mailing address Check here if all account owners share this address Street Address: Mailing Address for this account (if in US, complete Acknowledgment of US Mailing Address form) Check here if all account owners share this address Street address: Selection of security feature Mobile CAD Physical CAD Mobile No: Model No: Additional Account Owner Name (Print Name): SS# or Tax ID: of Birth: Place of birth: Citizenship: U.S. U.S. Permanent Resident Alien(green card) Non-U.S./Country of Citizenship: Other countries of citizenships: Marital Status (Check One): Single Domestic Partner Divorced Widowed Married If married, spouse s Citizenship: Spouse s other country of citizenship: Home phone: Business phone: Mobile: Primary: address: Alt address: Permanent Legal Address for this Account (For Individual or Entity) Check here if permanent legal address is same as mailing address Check here if all account owners share this address Street Address: Mailing Address for this account (if in US, complete Acknowledgment of US Mailing Address form) Check here if all account owners share this address Street address: Selection of security feature Mobile CAD Physical CAD Mobile No: Model No: 2

3 II. Additional information Primary Account Owner Information (Print Name): Financial Information: Source of Wealth (check all that apply) Compensation Inheritance/Gift Real Estate Business Ownership Tax Bracket: % Primary source of income: Estimated Annual Compensation: Estimated Liquid Net Worth Security Investments Private Investments Other (specify): Employment (Check One): Employed Self-Employed Unemployed Retired Student Employer Name: Employer Address: Relationship to Other Account Participants: 1. Self Retirement Assets: Nature of Business: Other sources of income: Estimated Total Annual Income: Occupation: Estimated Total Net Worth (excluding primary residence) Years employed: Professional Affiliations Are you or a member of your household a: Director, Executive Officer or 10% Shareholder of a Company. A senior officer of a financial institution. A senior foreign political figure (must complete PEP Questionnaire). Employed by another broker/dealer (B/D), a stock exchange or FINRA Registered OR Have a financial interest in or able to make decisions in an account at another B/D. Employed by StateTrust or related to a StateTrust Employee. Employer or broker/dealer name: StateTrust Division: Person s Relationship to StateTrust Employee: StateTrust Employee s Social Security Number: Investment Knowledge General Investment Knowledge and Experience (Check One): None Limited Moderate Extensive Product Type Knowledge None Limited Moderate Extensive Equities Fixed Income Options & Derivatives Commodities & Futures Mutual Funds Preferred Stocks Structured Products Hedge Funds Private Equity Money Markets & CDs Exchange Traded Products CDOs International Markets (currency or sovereign risk) Annuities Investing Since (Year) 3

4 2. 2. Additional Account Owner Information (Print Name): Financial Information: Source of Wealth (check all that apply) Compensation Inheritance/Gift Real Estate Business Ownership Tax Bracket: % Primary source of income: Estimated Annual Compensation: Estimated Liquid Net Worth Security Investments Private Investments Other (specify): Employment (Check One): Employed Self-Employed Unemployed Retired Student Employer Name: Employer Address: Relationship to Other Account Participants: Self 3. Retirement Assets: Nature of Business: Other sources of income: Estimated Total Annual Income: Occupation: Estimated Total Net Worth (excluding primary residence) Years employed: Professional Affiliations Are you or a member of your household a: Director, Executive Officer or 10% Shareholder of a Company. A senior officer of a financial institution. A senior foreign political figure (must complete PEP Questionnaire). Employed by another broker/dealer (B/D), a stock exchange or FINRA Registered OR Have a financial interest in or able to make decisions in an account at another B/D. Employed by StateTrust or related to a StateTrust Employee. Employer or broker/dealer name: StateTrust Division: Person s Relationship to StateTrust Employee: StateTrust Employee s Social Security Number: Investment Knowledge General Investment Knowledge and Experience (Check One): None Limited Moderate Extensive Product Type Knowledge None Limited Moderate Extensive Equities Fixed Income Options & Derivatives Commodities & Futures Mutual Funds Preferred Stocks Structured Products Hedge Funds Private Equity Money Markets & CDs Exchange Traded Products CDOs International Markets (currency or sovereign risk) Annuities Investing Since (Year) 4

5 3. 3. Additional Account Owner Information (Print Name): Financial Information: Source of Wealth (check all that apply) Compensation Inheritance/Gift Real Estate Business Ownership Tax Bracket: % Primary source of income: Estimated Annual Compensation: Estimated Liquid Net Worth Security Investments Private Investments Other (specify): Employment (Check One): Employed Self-Employed Unemployed Retired Student Employer Name: Employer Address: Relationship to Other Account Participants: Self Retirement Assets: Nature of Business: Other sources of income: Estimated Total Annual Income: Occupation: Estimated Total Net Worth (excluding primary residence) Years employed: Professional Affiliations Are you or a member of your household a: Director, Executive Officer or 10% Shareholder of a Company. A senior officer of a financial institution. A senior foreign political figure (must complete PEP Questionnaire). Employed by another broker/dealer (B/D), a stock exchange or FINRA Registered OR Have a financial interest in or able to make decisions in an account at another B/D. Employed by StateTrust or related to a StateTrust Employee. Employer or broker/dealer name: StateTrust Division: Person s Relationship to StateTrust Employee: StateTrust Employee s Social Security Number: Investment Knowledge General Investment Knowledge and Experience (Check One): None Limited Moderate Extensive Product Type Knowledge None Limited Moderate Extensive Equities Fixed Income Options & Derivatives Commodities & Futures Mutual Funds Preferred Stocks Structured Products Hedge Funds Private Equity Money Markets & CDs Exchange Traded Products CDOs International Markets (currency or sovereign risk) Annuities Investing Since (Year) Interested Party This account will have duplicate copies of certain correspondence delivered to either a secondary owner(s) or a third party. A SEPARATE FORM IS REQUIRED. 5

6 III. Account Handling Trade Settlement/Sweep Option All trades require 100% cash balance in your settlement account at the time you place your order. When I select a trade settlement/sweep option, payment for my transactions will be drawn from that option and proceeds from any sales transactions will be credited to that option. COR Insured Deposits (DLD) (no minimum) Retail Class: $50, minimum - (please specify)*: Treasury Class: $100, minimum - (please specify)*: Institutional: $5,000, minimum-(please specify)*: Other - (please specify): Do Not Sweep proceeds to Money Market * Consult your investment firm for available options. Dividend Reinvestment Reinvest dividends into additional shares automatically (fees may apply). Speak to your advisor to select which dividends to reinvest. W-9 Certification Under penalties of perjury I certify that: 1) The taxpayer identification number shown on this form is my correct taxpayer identification number. 2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Services (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) The IRS has notified me that I am no longer subject to backup withholdings, and 3) I am a US Person including a US resident alien (defined in the W-9 Instructions which will be provided upon request). 4) The FATC code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions: you must cross out item 2 above if you have been notified by the IRS that you are currently subjected to backup withholdings because you have failed to report all interest and dividends on your tax return. Check appropriate reporting type: Individual/ Sole Proprietor Corporation Partnership Limited Liability Company Enter the tax classification (D=Disregard Entity, C=Corporation, P=Partnership) Other Exempt payee S Corporation Exemption from FATCA Reporting code (if any 6

7 IV. Acceptance of Terms and Conditions of Agreements (Please read and sign below) U.S. Federal law requires us to obtain, verify and record information that identifies each person or entity that opens an account. What this means for you is that when you open an account, we will ask you for your name, a street address, date of birth, and an identification number, such as a Social Security No. or other identification number that Federal law requires us to obtain. We may also ask to see a driver s license, corporate formation document (for corporate entities) or other identifying documents that will allow us to identify you or the corporate entity seeking to open an account. We appreciate your cooperation. CAD security program: StateTrust s CAD security program involves the use of digital access codes, generated by an application or token, to authenticate the identity of our customers and prevent fraud attempts on their accounts. This program helps protect the confidentiality of our customers data, allowing it to be accessed only by those authorized to do so. This method of authentication will be used prior to disseminating any account information for instances such as confirm transfer instructions and investments in an account, receive assistance for access and use of our electronic platforms, receive confidential information and customized assistance on accounts and portfolios, and other assistance in general. Investment Products: NOT FDIC INSURED, NOT A BANK DEPOSIT, NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY, NO BANK GUARANTEE, MAY LOSE VALUE. I hereby request that COR Clearing LLC ( COR ) and StateTrust Investments, Inc. ( StateTrust ) open an account in the name(s) listed as account owner(s) on this application. By signing below, I acknowledge that I have received, read, understand and agree to be bound by the terms & conditions as set forth in the Customer Agreement ( Customer Agreement ) as currently in effect and as amended from time to time. I represent that I am of required legal age to enter into this Agreement. I understand and acknowledge that COR does not provide investment, tax, legal, accounting, financial or other advice. I agree to notify StateTrust Investments of any status change to my account registration. Please note: COR and StateTrust will verify information provided on this form through a third-party provider in accordance with the USA Patriot Act. Special note: with respect to assets custodied by COR on my behalf, I acknowledge that income and capital gains or distributions to me from this account may be taxable in my home jurisdiction. Furthermore, interest paid to COR under this agreement, such as but not limited to margin interest, may be subject to withholding tax in my home jurisdiction. It is my obligation to pay such withholding tax, if applicable. I acknowledge to StateTrust and to COR that I have taken my own tax advice to this regard. Disclosure: When a customer sends a payment instruction to StateTrust Investments (STI) that exceeds the minimum security amount level as defined by the company, STI will proceed to confirm and authenticate the payment instructions, at its own discretion. Please note that instructions will not be executed until the security and compliance procedures are completed in a satisfactory manner. Additional support documentation and identification of beneficiaries may be requested. Minimum Security Amount Level: $0.00 USD (all transactions will be subject to call-back verification procedure). This agreement may be signed by the client and delivered by facsimile or PDF, transmission, all of which shall be deemed as the original version for all purposes. All foreign joint accounts are classified as joint with rights of survivorship. WITH MY SIGNATURE ON THE ACCOUNT APPLICATION, I ACKNOWLEDGE THAT I HAVE RECEIVED, READ, UNDERSTOOD AND AGREED TO THE TERMS SET FORTH IN THE FOREGOING AGREEMENT. Account Owner Signature Financial Advisor Signature General Principal 7