FIRST PRIVATE EQUITY GROUP GENERAL INFORMATION EMPLOYMENT CLIENT PROFILE 0 Income 0 Growth 0 Soreuts•on 0 Seely ol Princcat 0 Tax Freeteteried 0 Ode, Cozensno First Private Equity Group 70 Pine Street, New York, N.Y. 10005 Phone 1-212-937-3623 Fax 1-212-656-1857 Email [email protected] Net Worth (orectutling reeMence) Is Winos piny or an immildan lemay member inhalod with or cepesect by key tecureaS inn. bank. trust 01 i eisiree eteneanitt ❑Yas ONO 11 yes. vital hen and position' is oche. party or an Immediate Witty mentor a cieecer. a 10% greater tharehneer, ors polcipMerung execs:We olker of a suably trudge company' 0 Yes 0 No yos. what Wm and poskeno Intestine, Einem:rim Stocks Bonds Fume. Onions None 0 0 0 0 Lrolo 0 0 0 0 Moderate 0 0 0 0 Extensive 0 0 0 0 Risk Tolerance Tax Packet C lox 0 0-15% 0 29-36% C Moderate 0 16-26% 0 36%. C High ACCOUNT INFORMATION Mitt Trareacias Type: Selbeed Type of Account. 0 Buy 0 See 0 Sorel Dan*, 0 Cash 0 Margin 0 °plea O Irsfrodual O twestment Mb • 0 TruSI CI Deposit 0 'bander Symbol. Noe or Regbelti0n O Partnershp• 0 Corporation • 0 Invastmert Advisor 0 Charitable 0 cussen 0 Tenants asCommon K Our 0 Joint Tenants ARMS MRerenms*• ' Additinial Doane= Flepared CERTIFICATION OFFICE USE ONLY I hereby Carley mat the information retake on this born is bpi. caret' and complete to MO WSI ol my krowlediat Cerarcaam Stamen( (All poisons must sign 4 Vie is a joie accw'*I Signature Dale X SOMYSO Dale Should you *see a margin or open account. Ouse sign and COM01010 IN MARGIN AGREEMENT/LOAN CONSENT FORM or OPT ION AG REUSE NT. ACe°4n. OM's) By: Rep Sputure Branch Manager &Datum. 0 °win Agreemeol Gout. Delo. Date EFTA01237426