Common use of Form of Ownership Clause in Contracts

Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] Individual [ ] Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7) [ ] Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] XXX [ ] XXXXX [ ] Pension or Profit Sharing Plan [ ] Trust Trustee's Name: __________________________________________ Trust Date: ______________________________________________ [ ] Other: Provide detailed information in the space immediately below.

Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] / / Individual [ ] / / Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7below) [ ] / / Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] / / XXX [ ] / / XXXXX [ ] / / Pension or Profit Sharing Plan [ ] / / Trust Trustee's Name: __________________________________________ Trust Date: ______________________________________________ [ ] / / Other: Provide detailed information in the space immediately below.

Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] / / Individual [ ] / / Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7below) [ ] / / Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] / / XXX [ ] / / XXXXX [ ] / / Pension or Profit Sharing Plan [ ] / / Trust Trustee's Name: _________________________________________________ Trust Date: _________________________________________________ [ ] / / Other: Provide detailed information in the space immediately below.

Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] ? Individual [ ] ? Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7below) [ ] ? Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] ? XXX [ ] ? XXXXX [ ] ? Pension or Profit Sharing Plan [ ] ? Trust Trustee's Name: __________________________________________ Trust Date: ______________________________________________ [ ] ? Other: Provide detailed information in the space immediately below.

Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. [ ] / / Individual [ ] / / Joint Tenants with Right of Survivorship (Both signatures must appear in Item 7below) [ ] / / Corporation or Partnership (Corporate Resolutions or Partnership Agreement must be enclosed) [ ] / / XXX [ ] / / XXXXX [ ] / / Pension or Profit Sharing Plan [ ] / / Trust Trustee's Name: __________________________________________ Trust Date: ______________________________________________ [ ] / / Other: Provide detailed information in the space immediately below.