Structured Products Agreement and Approval Form Please Complete All Sections Accoutki Account Ham; WIG - o 2 33,c)li sfx, ilerS-t K) N A/Qc AL LL c_. Account Type arin.v•Phil ($9004). !aMtivilltital.:yetroluity I.w loralion NOTE: IRA and ERISA accounts are prohibited from purchasing Structured Products. Account and Owner Information: Provide requested inhumation for each beneticial account owner (tong. If more than one owner exists. !ha Structured Products Agreement and AppiovaiSuroontentary Form to this Agreement may be tequired. loot; Nanµ. Malelle. Lan Name nl IntImdua Teu.iev el El.:cuInt -re--CP2.€-_•`1 G 9 51-6- I JJ ndtven I cic) Rco 1-V ic) \< c&k\ONet 132 CnUntrY US VW..G‘s. s-r -rNotAAS Ilvil•Uni nt 0rpendetitc MA, nal Sialirs S\)/ - MfaCOlrf vv of CmCgOvN SGL4 Pus. Pngiv• Invest Dann> Pennon VoNS I tell 410 pcovccrics owNet (0* lioatal S) a! Ira , aa(S) atlag !Km httatial OWlia, (51 MilltDoitd to Pl3C0 Orders los t he account L "kR2Y-C--1-1- 5 DAR.Leic.) Client(s) Financial Information Approximate. Aggregate Annual Income of Account (Approximate) Owner(s) from All Sources Less than $50,000 550,000 - 599.999 5100,000 - 5249.999 5250.000 -5499,399 `,500.000- 5999.999 :".1.000,000 - Y2,499.999 ::,2.500.000 - $4,999,999 .5.000,000 and over 7 11 1n! !aim nest o O017.3330n Sources of Income Salary/Bonus Interest s 193 Other (specify): Approgimate Net Worth Less than S50,000 550.000 - 599.999 5100,000 - S249,999 $250,000 -$499.999 ya S500.000- S999.999 91,000.000 - 82.499,999 52,500.000 34.999.999 ApproLimate Liquid Nat Worth Excluding Principal Residence Less than $50,000 S50.000 - 599.999 5100.000 - 5249.999 5250.000 - S499,999 5500.000 - $999.999 51.000.000- 52.499.999 52.500.000 - 54,999.99s ( S5.000,000 and ovl IMEe tee paw oi 5 aA9349-30830 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) EFTA_000 19700 EFTA00169427