Please fill out all of the applicable fields and send to Interactive Brokers by any of the methods below: Email: fullservicefa@interactivebrokers.com Courier/Overnight Service: Interactive Brokers LLC Document Processing 209 South LaSalle Street 10th Floor Chicago, IL 60604 Mail: Interactive Brokers LLC Document Processing P.O. Box A3770 Chicago IL 60690-3770 1
INTERACTIVE BROKER SUPPLEMENTAL POWER OF ATTORNEY AND AUTHORIZATION FORM FOR CLIENTS OF INDEPENDENT FINANCIAL ADVISORS Use this form to authorize your financial advisor to perform additional tasks related to your Interactive Brokers ( IB ) account. You must also include a photocopy of your driver s license or passport or governmentissued identity card for signature verification. Name of Advisor: Advisor Master Acct. Number: Client Account Number(s): (NOTE: if you want these elections to apply to multiple accounts for same owner(s), provide all acct numbers. Account Holder Name: Joint Account Holder (if any): * * * In addition to the authority granted to the above Advisor pursuant to the IB Discretionary Trading Authorization/Power Of Attorney For Financial Advisor, I (we) hereby authorize Advisor as follows: Initial in the Box All that Apply (leave blank if you do not want to grant the authorization): Authorization to Update or Change Account Information, Account Settings, Trading Permissions and Tax Forms: I (we) hereby authorize Advisor to update and change information regarding the account including but not limited to address and email address, phone number, financial information, trading objectives, products eligible to be traded, authorized traders, account settings and security settings, tax forms, etc. Authorization to Provide or Change Banking and Transfer Instructions: I (we) hereby authorize Advisor to add, change or delete banking and transfer instructions for the account including but not limited to bank account information, wire transfer instructions, ACH instructions and ACATs and other security and position transfer instructions. Authorization to Send Third Party Payments and Wires: I (we) hereby authorize Advisor to transmit payments or assets from the account to third parties including wire transfers, ACH transfers and other transfers of funds or assets. Check here if you want to place maximum limits on this authority (e.g., no more than $5,000 per 3 month period): Per Limit Amount Number of Months (1 12) 2
Authorization to Vote Shares and Make Elections Regarding Positions: I (we) hereby authorize Advisor to be sent communications regarding proxies, tender offers, proposed mergers, rights offerings, exchange offers and warrants, among other things, that may require a voting decision or other action and I (we) authorize Advisor to vote proxy ballots, provide instructions regarding corporate reorganizations and other corporate actions and take all actions on my (our) behalf. I (we) generally will not be sent copies of communications regarding the foregoing. Authorization for Special Programs and Alternative Investments: I (we) hereby authorize Advisor to enroll the account in special programs and alternative investments and to sign agreements related thereto, including but not limited to making hedge fund investments and enrolling in the IB Stock Yield Enhancement Program in which fully paid and excess margin securities are loaned out and loan fees are paid to the account. Request to Send Electronic Notices, Confirmations and Account Statements only to Advisor: Rather than have IB send electronic correspondence related to my account to my personal email address, for my convenience I hereby instruct IB to send all electronic correspondence to an email address of my Advisor, or set up by my Advisor on my behalf to which my Advisor has access. I explicitly assume the risk of relying on my Advisor for information regarding my account rather than receiving correspondence directly from Interactive Brokers. * * * BY SIGNING BELOW, YOU, THE ACCOUNT OWNER(S) AGREE AND ACKNOWLEDGE: You have received and read this agreement, and you understand and agree to its terms. If you have accounts with multiple Interactive Brokers entities worldwide for trading various international products, this Supplemental Power Of Attorney And Authorization Form will apply. 1. You authorize IB to accept instructions from your authorized Advisor consistent with the terms of this Supplemental Power Of Attorney And Authorization Form. 2. You accept full responsibility for understanding the risks associated with granting authority to your Advisor, and you assume sole liability for the financial, tax, and other consequences of all actions and instructions of the Advisor. 3. This Supplemental Power Of Attorney And Authorization Form will remain in effect until IB is notified in writing of your death, mental disability, incompetence or incapacity or until you have revoked it by written notification, and such notification is received by IB. Such revocation will not affect your obligations for transactions initiated prior to IB s processing the notice of revocation. 4. Interactive Brokers reserves the right, in it sole discretion, to refuse to honor particular instructions from Advisor, or to no longer honor instructions from Advisor. 5. You understand and accept that: ADVISOR WAS SELECTED SOLELY BY YOU AND HAS NOT BEEN RECOMMENDED OR ENDORSED BY IB. ADVISOR IS NOT EMPLOYED BY OR ASSOCIATED WITH IB IN ANY WAY. 3
IB WILL NOT INVESTIGATE OR JUDGE THE COMPETENCE OR INTEGRITY OF THE ADVISOR OR MONITOR THE ACTIONS OF THE ADVISOR. IB WILL NOT REVIEW THE ADVISOR'S RECOMMENDATIONS OR JUDGE THE SUITABILITY OF ANY TRADING OR INVESTMENT RECOMMENDATION. IB DOES NOT PROVIDE ADVISORY SERVICES TO IB CUSTOMERS AND WILL NOT PROVIDE INVESTMENT OR TRADING OR TAX ADVICE REGARDING THE ACCOUNT. IB IS NOT LIABLE FOR THE ACTIONS OR ANY INACTION OF YOUR ADVISOR. 6. Indemnification and Waiver: You agree to indemnify and hold Interactive Brokers, and its affiliates, and its and their successors and assigns, and its and their directors, officers, employees and Advisors harmless from and against all claims, actions, costs and liabilities, including attorney's fees, arising out of or relating to their reliance on this Supplemental Power Of Attorney And Authorization Form or their execution of any of Advisor's instructions. Customer agrees that since Interactive Brokers will not supervise or monitor Advisor's trading decisions or other activities, Customer will not attempt to hold Interactive Brokers liable for any trade or decision or action of Advisor. Interactive Brokers' rights under this paragraph are in addition to any other rights it has under other agreements with Customer and/or Advisor. 7. Arbitration: This Supplemental Power Of Attorney And Authorization Form and the agreements between you and Interactive Brokers contain an arbitration clause requiring all parties to arbitrate any disputes. You acknowledge that all disputes regarding this Authorization Agreement, Customer's account(s) or IB's provision of services to Customer or Advisor are subject to arbitration. In such arbitration: ALL PARTIES TO THIS AGREEMENT ARE GIVING UP THE RIGHT TO SUE EACH OTHER IN COURT, INCLUDING THE RIGHT TO A TRIAL BY JURY, EXCEPT AS PROVIDED BY THE RULES OF THE ARBITRATION FORUM IN WHICH A CLAIM IS FILED. ARBITRATION AWARDS ARE GENERALLY FINAL AND BINDING; A PARTY'S ABILITY TO HAVE A COURT REVERSE OR MODIFY AN ARBITRATION AWARD IS VERY LIMITED. THE ABILITY OF THE PARTIES TO OBTAIN DOCUMENTS, WITNESS STATEMENTS AND OTHER DISCOVERY IS GENERALLY MORE LIMITED IN ARBITRATION THAN IN COURT PROCEEDINGS. THE ARBITRATORS DO NOT HAVE TO EXPLAIN THE REASON(S) FOR THEIR AWARD UNLESS, IN AN ELIGIBLE CASE, A JOINT REQUEST FOR AN EXPLAINED DECISION HAS BEEN SUBMITTED BY ALL PARTIES TO THE PANEL AT LEAST 20 DAYS PRIOR TO THE FIRST SCHEDULED HEARING DATE. THE PANEL OF ARBITRATORS MAY INCLUDE A MINORITY OF ARBITRATORS WHO WERE OR ARE AFFILIATED WITH THE SECURITIES INDUSTRY. THE RULES OF SOME ARBITRATION FORUMS MAY IMPOSE TIME LIMITS FOR BRINGING A CLAIM IN ARBITRATION. IN SOME CASES, A CLAIM THAT IS INELIGIBLE FOR ARBITRATION MAY BE BROUGHT IN COURT. THE RULES OF THE ARBITRATION FORUM IN WHICH THE CLAIM IS FILED, AND ANY AMENDMENTS THERETO, SHALL BE INCORPORATED INTO THIS AGREEMENT. EXECUTED AND AGREED BY: If Individual or Joint Account: Signature of Account Holder 4
Signature of Joint Account Holder (Note: Both account holders must sign if it is a joint account.) If Organization, Corporation, Partnership or Trust Account: Signature of Authorized Officer or Trustee Name and Title of Officer or Trustee Advisor acknowledges and agrees: * * * TO BE COMPLETED BY ADVISOR: 1. Advisor has received and read this Supplemental Power Of Attorney And Authorization Form, and Advisor understands and agrees to its terms. 2. Please be aware that you may be deemed to have custody over client funds under federal and/or state securities law if your clients use the Interactive Brokers Supplemental Power of Attorney Form to provide you with authorization to provide or change banking or transfer instructions or authorization to send third party payments and wires. Please consult with your legal counsel and comply with applicable SEC and/or state rules before your clients delegate any powers to you that would make you a custodian under federal or state law. 3. Advisor represents that Advisor or Advisor s counsel has examined applicable U.S. state and federal laws and regulations, and/or the laws and regulations in the countries in which Advisor operates ( Laws and Regulations ), and Advisor represents that it is now, and will remain, in material compliance with all applicable Laws and Regulations in connection with the activities contemplated by this agreement. Advisor is solely responsible for complying with the Laws and Regulations. Among other things, Advisor is solely responsible for: (i) determining whether Advisor and/or its employees is required to be registered or licensed with appropriate regulatory authorities, and complying with any registration requirements; (ii) satisfying fiduciary obligations to its advisory clients; (iii) proper disclosure of material facts regarding the advisory services it provides; (iv) proper recordkeeping and reporting regarding the advisory services; (v) compliance with custody rules governing advisors; and (vi) compliance with anti-money laundering rules governing advisors. 4. Advisor agrees to provide prompt written notice to IB of any material change in any information regarding any Customer. Advisor agrees to provide prompt written notice of any Customer s death, mental disability, incompetence or incapacity or the revocation of Advisor s authority over Customer s account, or Customer s termination of its relationship with Advisor. 5. Advisor will provide immediate written notice by overnight mail or courier service to the attention of the IB Compliance Department in the event of any change in Advisor's registration, licensing or exemption status, including but not limited to any lapse in registration or licensing or any change or any suspension or bar or other material adverse regulatory action affecting Advisor. 5
6. Indemnification of Interactive Brokers by Advisor: Advisor agrees to indemnify and hold Interactive Brokers, and its affiliates, and its and their successors and assigns, and its and their directors, officers, employees and agents harmless from and against all claims, actions, costs and liabilities, including attorney's fees, arising out of or relating to any breach by Advisor of any provision of this Agreement or other Agreements with Interactive Brokers and/or Customer; the performance or non-performance of the Advisor's services; any trade or action of Advisor; and any dispute involving Advisor and/or Customer. Without limiting the generality of the foregoing, Advisor is solely responsible for the accuracy and completeness of all information and instructions provided by Advisor to Interactive Brokers regarding Customer accounts, including but not limited to Customer personal and financial information and trading objectives, banking and transfer instructions (including but not limited to bank account information, wire transfer instructions and ACH instructions) and proxy and other corporate action instructions, and Advisor agrees to indemnify and hold Interactive Brokers harmless for any loss or harm resulting from inaccurate information or instructions. Interactive Brokers' rights under this paragraph are in addition to any other rights it has under other agreements with Customer and/or Advisor. 7. Arbitration: Any dispute concerning this Supplemental Power Of Attorney And Authorization Form is subject to the arbitration clause contained in the agreements between Advisor and Interactive Brokers requiring all parties to arbitrate any disputes. Advisor acknowledges that all disputes regarding this Authorization Agreement, Customer's account(s) or IB's provision of services to Customer or Advisor are subject to arbitration in accordance with the Agreement for Advisors Providing Services to Interactive Brokers Customers Advisor governing the business relationship between IB and Advisor. Signature of Authorized Officer of Advisor Name and Title of Officer NOTE: A PHOTOCOPY OF THE CUSTOMER S DRIVER S LICENSE OR PASSPORT OR GOVERNMENT-ISSUED IDENTITY CARD MUST BE PROVIDED TO INTERACTIVE BROKERS ALONG WITH THIS FORM FOR SIGNATURE VERIFICATION FOR EACH ACCOUNT HOLDER. IF A CORPORATE OFFICER OR TRUSTEE IS SIGNING ON BEHALF OF A CUSTOMER THAT IS AN ORGANIZATION OR A TRUST, THAT OFFICER S DRIVER S LICENSE OR PASSPORT OR GOVERNMENT-ISSUED IDENTITY CARD MUST BE PROVIDED. 6