Common use of PRIMARY ACCOUNT HOLDER INFORMATION Clause in Contracts

PRIMARY ACCOUNT HOLDER INFORMATION. To help the government fight the funding of terrorism and money laundering activities, federal laws require that all financial organizations obtain, verify and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also require a copy of your driver’s license or other government-issued identifying document. Complete Step 2 for only the primary registration type (Individual or Entity). Include either the Social Security Number or the Employer Identification Number. If completed incorrectly, a new W9 will be required. First Name Middle Initial Last Name Entity Name (if applicable) Employer Identification Number (EIN) Social Security Number Date of Birth Specified Adult Yes No — — Email Address Home Phone Business Phone Mobile Phone Legal Address (no P.O. box) City State/Province Zip/Postal Code Country Mailing Address (if different from legal address) City State/Province Zip/Postal Code Country Previous Physical Address (if current address less than two years old) City State/Province Zip/Postal Code Country Citizenship Please check only one: U.S. U.S. Resident Alien Non-Resident Alien (please provide a valid Government ID and a form W-8) Additional Citizenship Primary Citizenship Employment and Industry Affiliations Employed Self-Employed Retired Unemployed Homemaker Student Employer Name Years Employed Occupation Employer’s Address City State/Province Zip/Postal Code Country Check if you are affiliated with a broker-dealer. If you are affiliated with a broker-dealer that is not your employer, please provide the name of that broker-dealer below. Broker-Dealer Name PRIMARY ACCOUNT HOLDER MAY INCLUDE OWNER, MINOR, XXXX OR ENTITY. UGMA/UTMA ACCOUNT: MINOR IS THE PRIMARY ACCOUNT HOLDER; CUSTODIAN IS THE SECONDARY ACCOUNT HOLDER. IF DISREGARDED ENTITY, ENTER INFORMATION FOR THE REGARDED/ OWNER. LIST DISREGARDED ENTITY IN THE ADDITIONAL ACCOUNT HOLDER SECTION. SPECIFIED ADULT: DEFINED BY FINRA AS (A) A PERSON AGE 65 AND ABOVE; OR (B) A PERSON AGE 18 OR ABOVE THAT IS UNABLE TO PROTECT HIS/HER OWN INTERESTS. IF YOU WISH TO ADD A TRUSTED CONTACT, PLEASE COMPLETE THE TRUSTED CONTACT SECTION. PROOF OF ADDRESS IS REQUIRED FOR EACH NON-US PERSON AND US CITIZENS LIVING ABROAD. IF EMPLOYED/ SELF-EMPLOYED IS INDICATED, PLEASE COMPLETE ALL EMPLOYMENT FIELDS. IF CHECKED, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL (AS REQUIRED BY FINRA RULE 3210). Check if a member of your immediate family is affiliated with a broker dealer. Broker-Dealer Name Employee Name Relationship Check if you are a member/employee or related to a member/employee of a national securities association (i.e. NYSE or FINRA). If checked, please list the affiliation here Check if you, or an immediate family member, are a director, 10% shareholder, policy-making officer or controlling person of a publicly traded company. If checked, please provide company(ies) and symbol(s)

Appears in 10 contracts

Samples: Account Application and Agreement, wbiinvestments.com, wbiinvestments.com

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PRIMARY ACCOUNT HOLDER INFORMATION. To help NOTE: Primary account holder may include owner, minor, ward, executor or entity. On a UGMA/UTMA account the government fight the funding of terrorism and money laundering activities, federal laws require that all financial organizations obtain, verify and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also require a copy of your driver’s license or other government-issued identifying document. Complete Step 2 for only minor is the primary registration type (Individual or Entity). Include either account holder, the Social Security Number or custodian is the Employer Identification Number. If completed incorrectly, a new W9 will be requiredsecondary account holder. First Name Middle Initial Last Name Entity Name (if applicable) Employer Date of Birth (mm/dd/yyyy) Gender Social Security Number Tax Identification Number (EINITIN) Social Security Number Date of Birth Specified Adult Married 🞏 Yes 🞏 No — — Email Address Dependents Home Phone Business Phone Mobile Phone Email Address Home 🞏 Own 🞏 Rent Legal Address (no P.O. boxPO Box) City State/Province Zip/Postal Code Country Mailing Address (if different from legal address) City StateState Zip/Province Postal Code City State Zip/Postal Code Country Previous Physical Address (if current address less than two years old) City State/Province Zip/Postal Code Country Citizenship Citizenship: Please check only one: U.S. U.S. Resident Alien Proof of address is required for each non-US Person and US Citizens living abroad. Non-Resident resident Alien (please must provide a valid Government ID and a form W-8W-8 🞏 U.S. 🞏 U.S. Resident Alien 🞏 Non-Resident Alien Country of legal and tax resident: 🞏 U.S 🞏 Other (specify)________________________ Previous Physical Address (if current is less than 6 months old) Additional Citizenship Primary Citizenship City State Zip/Postal Code Country Employment and Industry Affiliations 🞏 Employed 🞏 Self-Employed 🞏 Retired 🞏 Unemployed 🞏 Homemaker 🞏 Student If Employed/Self-Employed is indicated, please complete all employment fields. Employer Name Years Employed Occupation Employer’s Address City State/Province Zip/Postal Code State Zip Country Check if you are affiliated with a broker-dealer. If you are affiliated with a broker-dealer that is not your employer, please USA Patriot Act Information (Required by Federal Law) All applicants must provide the name of that broker-dealer information below. BrokerNon-Dealer Name PRIMARY ACCOUNT HOLDER MAY INCLUDE OWNERresident aliens must also include a completed W-8. 🞏 Driver’s License 🞏 Passport 🞏 State ID 🞏 Other Government-issued ID Place/Country of Issuance ID No: Issue Date (mm/yyyy) Expiration Date (mm/yyyy) Industry and Other Affiliations Are you, MINORyour spouse, XXXX OR ENTITY. UGMA/UTMA ACCOUNTor any other immediate family members, including parents, in -laws, siblings or dependents: MINOR IS THE PRIMARY ACCOUNT HOLDER; CUSTODIAN IS THE SECONDARY ACCOUNT HOLDER. 🞏 Yes 🞏 No IF DISREGARDED ENTITY, ENTER INFORMATION FOR THE REGARDED/ OWNER. LIST DISREGARDED ENTITY IN THE ADDITIONAL ACCOUNT HOLDER SECTION. SPECIFIED ADULT: DEFINED BY FINRA AS (A) A PERSON AGE 65 AND ABOVE; OR (B) A PERSON AGE 18 OR ABOVE THAT IS UNABLE TO PROTECT HIS/HER OWN INTERESTS. IF YOU WISH TO ADD A TRUSTED CONTACT, PLEASE COMPLETE THE TRUSTED CONTACT SECTION. PROOF OF ADDRESS IS REQUIRED FOR EACH NON-US PERSON AND US CITIZENS LIVING ABROAD. IF EMPLOYED/ SELF-EMPLOYED IS INDICATED, PLEASE COMPLETE ALL EMPLOYMENT FIELDS. IF CHECKEDCHECKED YES, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL Employed by or associated with the securities industry (AS REQUIRED BY FINRA RULE 3210for example, a sole proprietor, partner, officer, director, branch manager, registered representative or other associated person of a broker -dealer firm) or a financial services regulator? If yes, please specify entity below. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter (with this Application). Check if a member of your immediate family is affiliated with a broker dealer. 🞏 Broker-Dealer or Municipal Securities Dealer 🞏 Investment Adviser 🞏 FINRA or other Self-Regulatory Organization 🞏 State or Federal Securities Regulator Name Employee Name Relationship Check if you are a member/employee of Entity(ies): _________________________________________________ 🞏 Yes 🞏 No An officer, director or related to a member/employee of a national securities association (i.e. NYSE or FINRA). If checked, please list the affiliation here Check if you, or an immediate family member, are a director, 10% shareholder(or more) shareholder in a publicly-owned company? Name of company and symbol: __________________________ 🞏 Yes 🞏 No A senior military, policygovernmental or political official in a non-making officer or controlling person US country? Name of a publicly traded company. If checked, please provide company(ies) and symbol(s)country: _______________________ Account Number: -

Appears in 2 contracts

Samples: speedtrader.com, southeastinvestmentsnc.com

PRIMARY ACCOUNT HOLDER INFORMATION. To help the government fight the funding of terrorism and money laundering activities, federal laws require that all financial organizations to obtain, verify and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also require a copy of your driver’s license or other government-issued identifying document. Complete Step 2 for only the primary registration type (Individual or Entity). Include either the Social Security Number or the Employer Identification Number. If completed incorrectly, a new W9 will be required. First Name Middle Initial Last Name Entity Name (if applicable) Employer Identification Number (EIN) Social Security Number Date of Birth Specified Adult Yes No — — Email Address Home Phone Business Phone Mobile Phone Legal Address (no P.O. box) City State/Province Zip/Postal Code Country Mailing Address (if different from legal address) City State/Province Zip/Postal Code Country Previous Physical Address (if current address less than two years old) City State/Province Zip/Postal Code Country Citizenship Please check only one: U.S. U.S. Resident Alien Non-Resident Alien (please provide a valid Government ID and a form W-8) Additional Citizenship Primary Citizenship Employment Country of legal and Industry Affiliations Employed Self-Employed Retired Unemployed Homemaker Student Employer Name Years Employed Occupation Employer’s Address City State/Province Zip/Postal Code Country Check if you are affiliated with a broker-dealertax residence: U.S. Other (specify) *JOINT ACCOUNT AGREEMENT IS REQUIRED FOR TENANTS IN COMMON. If you are affiliated with a broker-dealer that is not your employer, please provide the name of that broker-dealer below. Broker-Dealer Name PRIMARY ACCOUNT HOLDER MAY INCLUDE OWNER, MINOR, XXXX XXXX, EXECUTOR OR ENTITY. UGMA/UTMA ACCOUNT: MINOR IS THE PRIMARY ACCOUNT HOLDER; CUSTODIAN IS THE SECONDARY ACCOUNT HOLDER. IF DISREGARDED ENTITY, ENTER INFORMATION FOR THE REGARDED/ OWNER. LIST DISREGARDED ENTITY IN THE ADDITIONAL ACCOUNT HOLDER SECTION. SPECIFIED ADULT: DEFINED BY FINRA AS (A) A PERSON AGE 65 AND ABOVE; OR (B) A PERSON AGE 18 OR ABOVE THAT IS UNABLE TO PROTECT HIS/HER OWN INTERESTS. IF YOU WISH TO ADD A TRUSTED CONTACT, PLEASE COMPLETE THE TRUSTED CONTACT SECTION. PROOF OF ADDRESS IS REQUIRED FOR EACH NON-US PERSON AND US CITIZENS LIVING ABROAD. Employment and Industry Affiliations Employed Self-Employed Retired Unemployed Homemaker Student Employer Name Years Employed Occupation Employer’s Address City State/Province Zip/Postal Code Country Check if you are affiliated with a broker-dealer. Check if a member of your immediate family is affiliated with a broker dealer. Name of Family Member If your broker-dealer affiliation is not with the employer listed above, please provide the name and address of the affiliated entity and the nature of the affiliation below. Affiliated Entity’s Name and Address Nature of the Affiliation Check if you, or an immediate family member, are a director, 10% shareholder, policy-making officer or controlling person of a publicly traded company. IF EMPLOYED/ SELF-EMPLOYED IS INDICATED, PLEASE COMPLETE ALL EMPLOYMENT FIELDS. IF CHECKED, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL (AS REQUIRED BY FINRA RULE 3210). Check if a member of your immediate family is affiliated with a broker dealer. Broker-Dealer Name Employee Name Relationship Check if you are a member/employee or related to a member/employee of a national securities association (i.e. NYSE or FINRA). If checked, please list the affiliation here Check if you, or an immediate family member, are a director, 10% shareholder, policy-making officer or controlling person of a publicly traded company. If checked, please provide company(ies) and symbol(s)

Appears in 1 contract

Samples: Account Application and Agreement

PRIMARY ACCOUNT HOLDER INFORMATION. To help NOTE: Primary account holder may include owner, minor, ward, executor or entity. On a UGMA/UTMA account the government fight the funding of terrorism and money laundering activities, federal laws require that all financial organizations obtain, verify and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also require a copy of your driver’s license or other government-issued identifying document. Complete Step 2 for only minor is the primary registration type (Individual or Entity). Include either account holder, the Social Security Number or custodian is the Employer Identification Number. If completed incorrectly, a new W9 will be requiredsecondary account holder. First Name Middle Initial Last Name Social Security Number Date of Birth (mm/dd/yyyy) Gender ⭘ M ⭘ F ⭘ No Answer Marital Status ⭘ Married ⭘ Single ⭘ Divorced ⭘ Widowed Dependents Home ⭘ Own ⭘ Rent Complete for Accounts Owned by Individuals only – Do not use for authorized parties on Entity accounts (see STEP 3) Entity Name (if applicable) Employer Formation Date Tax Identification Number (EIN) Social Security Number Date of Birth Specified Adult Yes No — — Email Address - Complete for Accounts Owned by Entities only – Corporation, Estate, Trust, LLC, Partnership, Etc. Complete for all Account Types Contact Information Home or Mobile Phone Business Phone Mobile Foreign Phone Legal Email Address Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address(es) Physical Address (no P.O. boxPO Box) City State/Province Zip/Postal Code Country Mailing Address (if different from legal addressPhysical) City State/Province Zip/Postal Code Country Previous Physical Address (if current address Physical is less than two years 6 months old) City State/Province Zip/Postal Code Country Citizenship Please check only one: U.S. U.S. Resident Alien Proof of address is required for each non-US Person and US Citizens living abroad. Non-Resident Alien (please must provide a valid Government ID and a form W-8 ⭘ U.S. ⭘ U.S. Resident Alien ⭘ Non-Resident Alien Country of legal and tax resident: ⭘ U.S ⭘ Other (specify)________________________ USA Patriot Act Information (Required by Federal Law) All applicants must provide the information below. Non-Resident aliens must also include a completed W-8. ⭘ Driver’s License ⭘ Passport ⭘ State ID ⭘ Foreign Tax ID ⭘ Other Government-issued ID Place/Country of Issuance ID No: Issue Date (mm/dd/yyyy) Additional Citizenship Primary Citizenship Expiration Date (mm/dd/yyyy) Employment and Industry Affiliations Employed Self-Employed Retired Unemployed Homemaker Student If Employed/Self-Employed is indicated, please complete all employment fields. If Retired or Unemployed is indicated, please indicate former Occupation. Employer Name Years Employed Phone Number Occupation Business Nature Employer’s Address City State/State Zip Code Country Province Zip/Foreign Postal Code Country Check if you are affiliated with a broker-dealer. If you are affiliated with a broker-dealer that is not your employer, please provide the name of that broker-dealer below. Broker-Dealer Name PRIMARY ACCOUNT HOLDER MAY INCLUDE OWNER, MINOR, XXXX OR ENTITY. UGMA/UTMA ACCOUNT: MINOR IS THE PRIMARY ACCOUNT HOLDER; CUSTODIAN IS THE SECONDARY ACCOUNT HOLDER. IF DISREGARDED ENTITY, ENTER INFORMATION FOR THE REGARDED/ OWNER. LIST DISREGARDED ENTITY IN THE ADDITIONAL ACCOUNT HOLDER SECTION. SPECIFIED ADULT: DEFINED BY FINRA AS (A) A PERSON AGE 65 AND ABOVE; OR (B) A PERSON AGE 18 OR ABOVE THAT IS UNABLE TO PROTECT HIS/HER OWN INTERESTS. IF YOU WISH TO ADD A TRUSTED CONTACT, PLEASE COMPLETE THE TRUSTED CONTACT SECTION. PROOF OF ADDRESS IS REQUIRED FOR EACH NON-US PERSON AND US CITIZENS LIVING ABROAD. IF EMPLOYED/ SELF-EMPLOYED IS INDICATED, PLEASE COMPLETE ALL EMPLOYMENT FIELDS. IF CHECKED, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL (AS REQUIRED BY FINRA RULE 3210). Check if a member of your immediate family is affiliated with a broker dealer. Broker-Dealer Name Employee Name Relationship Check if you are a member/employee or related to a member/employee of a national securities association (i.e. NYSE or FINRA). If checked, please list the affiliation here Check if you, or an immediate family member, are a director, 10% shareholder, policy-making officer or controlling person of a publicly traded company. If checked, please provide company(ies) and symbol(s)Account Number:

Appears in 1 contract

Samples: monmouthcm.com

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PRIMARY ACCOUNT HOLDER INFORMATION. To help NOTE: Primary account holder may include owner, minor, ward, executor or entity. On a UGMA/UTMA account the government fight minor is the funding of terrorism and money laundering activitiesprimary account holder, federal laws require that all financial organizations obtain, verify and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also require a copy of your driver’s license or other government-issued identifying documentthe custodian is the secondary account holder. Complete for Accounts Owned by Individuals only – Do not use for authorized parties on Entity accounts (see Step 2 for only the primary registration type (Individual or Entity). Include either the Social Security Number or the Employer Identification Number. If completed incorrectly, a new W9 will be required. 3) First Name Middle Initial Last Name Social Security Number Date of Birth (mm/dd/yyyy) Gender  M  F  No Answer Marriage Status  Married  Single  Divorced  Widowed Complete for Accounts Owned by Entities only – Corporation, Estate, Trust, LLC, Partnership, Etc. Entity Name (if applicable) Employer Identification Number (EIN) Social Security Number Industry Formation Date of Birth Specified Adult Yes No — — Email Address  EIN  SSN  TIN Number: Complete for all Account Types Contact Information Home Phone Mobile Phone Business Phone Mobile Phone Email Address Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address 1 Address 2 City State Zip Code Country Province Foreign Postal Code Address(es) Legal Address (no P.O. boxPO Box) City State/Province Zip/Postal Code Country Mailing Address (if different from legal addressLegal) City State/Province Zip/Postal Code Country Previous Physical Legal Address (if current address Legal is less than two years 6 months old) City State/Province Zip/Postal Code Country Citizenship Please check only (Choose one: U.S. U.S. Resident Alien ) Proof of address is required for each non-US Person and US Citizens living abroad. Non-Resident Alien (please must provide a valid Government ID and a form W-8  U.S.  U.S. Resident Alien Country of legal and tax resident:  U.S  Other (specify) USA Patriot Act Information (Required by Federal Law) All applicants must provide the information below. Non-Resident aliens must also include a completed W-8.  Driver's License Passport  State ID  Foreign Tax ID  Other Government-issued ID Place/Country of Issuance ID No: Issue Date (mm/dd/yyyy) Additional Citizenship Primary Citizenship Expiration Date (mm/dd/yyyy) Employment and Industry Affiliations Employed Self-Employed Retired  Unemployed  Homemaker  Student If Employed/Self-Employed is indicated, please complete all employment fields. If Retired Unemployed Homemaker Student or Unemployed, please indicate Retired or Unemployed. Employer Name Years Employed Occupation Employer’s Address City State/State Zip Code Country Province Zip/Foreign Postal Code Country Check if you are affiliated with a brokerCONTINUED TO NEXT PAGE Industry and Other Affiliations Are you, your spouse, or any other immediate family members, including parents, in-dealer. If you are affiliated with a broker-dealer that is not your employerlaws, please provide the name of that broker-dealer below. Broker-Dealer Name PRIMARY ACCOUNT HOLDER MAY INCLUDE OWNER, MINOR, XXXX OR ENTITY. UGMA/UTMA ACCOUNTsiblings or dependents: MINOR IS THE PRIMARY ACCOUNT HOLDER; CUSTODIAN IS THE SECONDARY ACCOUNT HOLDER.  Yes  No IF DISREGARDED ENTITY, ENTER INFORMATION FOR THE REGARDED/ OWNER. LIST DISREGARDED ENTITY IN THE ADDITIONAL ACCOUNT HOLDER SECTION. SPECIFIED ADULT: DEFINED BY FINRA AS (A) A PERSON AGE 65 AND ABOVE; OR (B) A PERSON AGE 18 OR ABOVE THAT IS UNABLE TO PROTECT HIS/HER OWN INTERESTS. IF YOU WISH TO ADD A TRUSTED CONTACT, PLEASE COMPLETE THE TRUSTED CONTACT SECTION. PROOF OF ADDRESS IS REQUIRED FOR EACH NON-US PERSON AND US CITIZENS LIVING ABROAD. IF EMPLOYED/ SELF-EMPLOYED IS INDICATED, PLEASE COMPLETE ALL EMPLOYMENT FIELDS. IF CHECKEDCHECKED YES, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL Employed by or associated with the securities industry (AS REQUIRED BY FINRA RULE 3210for example, a sole proprietor, partner, officer, director, branch manager, registered representative or other associated person of a broker-dealer firm) or a financial services regulator? If yes, please specify entity below. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter (with this Application). Check if a member of your immediate family is affiliated with a broker dealer. Broker-Dealer or Municipal Securities Dealer  Investment Advisor  FINRA or other Self-Regulatory Organization  State or Federal Securities Regulator Name Employee Name Relationship Check if you are a member/employee of Entity(ies):  Yes  No  Yes  No An officer, director or related to a member/employee of a national securities association (i.e. NYSE or FINRA). If checked, please list the affiliation here Check if you, or an immediate family member, are a director, 10% shareholder(or more) shareholder in a publicly-owned company? What is your title?  10% shareholder  CEO  CFO  COO  Other Officer A senior military, policygovernmental or political official in a non-making officer or controlling person US country? Name of a publicly traded company. If checked, please provide company(ies) and symbol(s)country:

Appears in 1 contract

Samples: Account Application and Agreement

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