• No results found

Investment Account Application and Client Agreement

N/A
N/A
Protected

Academic year: 2021

Share "Investment Account Application and Client Agreement"

Copied!
7
0
0

Loading.... (view fulltext now)

Full text

(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  PHC/ PIC  Sole proprietor  Other (Specify):

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

Time Horizon:  Less than 1 year

 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: Special notes on account handling:

1.

1. Primary Account Owner Name

(Print Name)

:

SS# or Tax ID: Date of Birth: Place of birth:

Citizenship:  U.S.

 U.S. Permanent Resident Alien(green card)  Non-U.S./Country of Citizenship:

Marital Status (Check One):  Single

 Domestic Partner  Divorced  Widowed  Married

If married, spouse’s Citizenship:

Spouse’s other country of citizenship: Other countries of citizenships:

Home phone: Business phone: Mobile: Primary:

Email address: Alt Email 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:

City: Country: Zip/ Postal code:

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:

City: Country: Zip/ Postal code:

Selection of security feature  Mobile CAD

 Physical CAD

(2)

2 2.

2. Additional Account Owner Name

(Print Name)

:

SS# or Tax ID: Date of Birth: Place of birth:

Citizenship:  U.S.

 U.S. Permanent Resident Alien(green card)  Non-U.S./Country of Citizenship:

Marital Status (Check One):  Single

 Domestic Partner  Divorced  Widowed  Married

If married, spouse’s Citizenship:

Spouse’s other country of citizenship: Other countries of citizenships:

Home phone: Business phone: Mobile: Primary:

Email address: Alt Email 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:

City: Country: Zip/ Postal code:

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:

City: Country: Zip/ Postal code:

Selection of security feature  Mobile CAD

 Physical CAD

Mobile No: Model No:

3.

3. Additional Account Owner Name

(Print Name)

:

SS# or Tax ID: Date of Birth: Place of birth:

Citizenship:  U.S.

 U.S. Permanent Resident Alien(green card)  Non-U.S./Country of Citizenship:

Marital Status (Check One):  Single

 Domestic Partner  Divorced  Widowed  Married

If married, spouse’s Citizenship:

Spouse’s other country of citizenship: Other countries of citizenships:

Home phone: Business phone: Mobile: Primary:

Email address: Alt Email 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:

City: Country: Zip/ Postal code:

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:

City: Country: Zip/ Postal code:

Selection of security feature  Mobile CAD

 Physical CAD

(3)

3

II. Additional information

1. 1. Primary Account Owner Information

(Print Name)

:

Financial Information:

Source of Wealth (check all that apply)

Employment (Check One):

 Employed  Self-Employed  Unemployed  Retired  Student

Relationship to Other Account Participants:

1. Self

2.

3.

 Compensation  Inheritance/Gift  Real Estate  Business Ownership  Security Investments  Private Investments  Other (specify): Tax Bracket: %

Primary source of income: Estimated

Annual Compensation: Employer Name:

Estimated Liquid Net Worth Employer Address:

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. Company Name: Title: Publicly Traded:  Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  A senior officer of a financial institution. Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  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.

Employer or broker/dealer name:

 Employed by StateTrust or related to a StateTrust Employee. 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 Investing Since (Year)

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)    

(4)

4

2. 2. Additional Account Owner Information

(Print Name)

:

Financial Information:

Source of Wealth (check all that apply)

Employment (Check One):

 Employed  Self-Employed  Unemployed  Retired  Student

Relationship to Other Account Participants:

1.

2. Self

3.

 Compensation  Inheritance/Gift  Real Estate  Business Ownership  Security Investments  Private Investments  Other (specify): Tax Bracket: %

Primary source of income: Estimated

Annual Compensation: Employer Name:

Estimated Liquid Net Worth Employer Address:

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. Company Name: Title: Publicly Traded:  Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  A senior officer of a financial institution. Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  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.

Employer or broker/dealer name:

 Employed by StateTrust or related to a StateTrust Employee. 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 Investing Since (Year)

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)    

(5)

5

3. 3. Additional Account Owner Information

(Print Name)

:

Financial Information:

Source of Wealth (check all that apply)

Employment (Check One):

 Employed  Self-Employed  Unemployed  Retired  Student

Relationship to Other Account Participants:

1.

2.

3. Self

 Compensation  Inheritance/Gift  Real Estate  Business Ownership  Security Investments  Private Investments  Other (specify): Tax Bracket: %

Primary source of income: Estimated

Annual Compensation: Employer Name:

Estimated Liquid Net Worth Employer Address:

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. Company Name: Title: Publicly Traded:  Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  A senior officer of a financial institution. Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No Company Name: Title: Publicly Traded:

 Yes  No  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.

Employer or broker/dealer name:

 Employed by StateTrust or related to a StateTrust Employee. StateTrust Division:

Person’s Relationship to StateTrust Employee: StateTrust Employee’s Social Security Number:

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.

Investment Knowledge

General Investment Knowledge and Experience (Check One): None Limited Moderate Extensive

Product Type Knowledge Investing Since (Year)

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)    

(6)

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: $50,000.00 minimum - (please specify)*:  Treasury Class: $100,000.00 minimum - (please specify)*:  Institutional: $5,000,000.00 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  Other

 Corporation  Exempt payee

 Partnership  S Corporation

 Limited Liability Company

Enter the tax classification (D=Disregard Entity, C=Corporation, P=Partnership) _____

(7)

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, email 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 Date

Additional Account Owner Signature Date

Additional Account Owner Signature Date

Additional Account Owner Signature Date

Additional Account Owner Signature Date

Financial Advisor Signature Date

References

Related documents

Any and all securities, or contracts relating thereto, now or hereafter held or carried by the Broker in any of your account (either individually or jointly

"The Bank is hereby requested and authorized with or without reference to me/us to report all information pertaining to the accounts and investments, opened/ maintained/made and

I understand that if I file a chapter 7, 11, or 13 bankruptcy within one year of having received a discharge in a previous bankruptcy, then the automatic stay will

Plan administrator’s mailing address (number, street) City Province Postal code Plan number(s) Account/Division number Union local Certificate number.. Province Address

FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.. Check to indicate if FILER is a (an): Payment settlement

PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no.. PAYER’S country code Check if branch reporting

VOID CORRECTED PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. PAYER’S country code Check if branch reporting

* Home Address (Street, City, State, Zip) Mailing Address (Street, City, State, Zip) * Telephone Number (area code) + (number) Email address.. Please list addresses in which