EX-10.2 13 a2188074zex-10_2.htm EXHIBIT 10.2

Exhibit 10.2

 

UBS Bank USA

Variable Credit Line Account Number: (if applicable)

5V

 

 

Fixed Credit Line Account Number: (if aaplicable)

Credit Line Account Application and

5F

 

 

Agreement for Organizations and Businesses

SS# / TIN

 

 

HB

 

Internal Use Only

 

For Internal Use Only

 

 

 

 

 

Variable Credit Line Account at UBS Bank USA

 

 

 

 

 

 

 

5V

 

 

 

 

Fixed Credit Line Account at UBS Bank USA

 

 

 

 

 

 

 

5F

 

 

 

 

 

Collateral Account(s) at UBS Financial Services Inc.

 

 

Insert the information below for each UBS Financial Services Inc. account to be pledged to secure the Borrower’s credit line.

Full Collateral (Securities) Account Title

Branch

Account Number

FA#

  1)

  2)

  3)

  4)

  5)

  6)

 

Credit Line Account

Select the type of credit line account:

 

 

o   Variable Credit Line Account

 

 

o   Fixed Credit Line Account

 

 

o   Both

 

 

 

 

 

If you do not indicate your preference you will be deemed to have selected the “Both” option.

 

Account Ownership

 

Select the Organization/Business Structure:

Is this entity / organization a

 

o Corporation

 

 

 

 

business that provides

 

o Corp- Subchapter ‘S’

 

o Fed Charter-Credit Union

 

o Fed Charter-Trust Co.

commercial goods or services (i.e., an operating entity)?

 

o Limited Liability Company (LLC)

 

o Foundation-not for profit

 

o Govt Agency-Federal

 

o Limited Liability Partnership (LLP)

 

o Endowment-not for profit

 

o Govt Agency-Local Ent

o  Yes   o  No

 

o Limited Liability-Limited

 

o State Charter-S&L Bank

 

o Govt Agency-State

 

 

     Partnership (LLLP)

 

o State Charter-Savings Bank

 

 

 

 

 

 

 

 

 

Any changes or corrections

 

o Sole Proprietorship

 

o State Charter-Comm Bank

 

 

to the information on this

 

o Partnership-General

 

o State Charter-Trust Co.

 

 

application must be initialed by

 

o Partnership-Limited

 

o State Charter-Credit Union

 

 

you.

 

o Association

 

o State Charter-Indus Loan

 

 

 

 

o Partnership-Invest Club

 

o Fed Charter-Savings Assoc

 

 

 

 

o Invest Club Membership

 

o Fed Charter-Nat’l Bank

 

 

 

Borrower Information

This section should be completed by the Organization/Business.

 

 

 

Borrower

 

 

Organization / Business Name

 

Location of Address

Organization/Business is (please complete each item that applies):

o Business - Primary

o Other (please specify)

1)

o Incorporated

 

o Unincorporated

 

2)

o For Profit

 

o Not For Profit

Street Address (If a P.O. Box, complete the Additional Address Information on

 

page 3 .):

Industry Group (e.g., Construction, Service, etc.):

 

 

Is the Organization/Business publicly listed?

o No

o Yes;  specify:

City:

State:

 

ZIP:

 

 

Business Telephone Number:

 

 

 

 

 

 

 

 

 

Exchange (NYSE, AMEX, or NASDAQ)

Ticker Symbol

 

 

 

 

 

Place of Formation / Incorporation

 

 

o

USA (if formed/incorporated, specify

 

 

 

State):

 

 

o

Other (specify)

 

 

 

 

 

 

TIN:

Date of Incorporation / Establishment:

 

 

 

 

 

HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

 

Ó 2008 UBS Bank USA. All rights reserved.

 

Sign and date the application on page 4

 



 

UBS Bank USA

Variable Credit Line Account Number: (if applicable)

5V

 

 

Fixed Credit Line Account Number: (if aaplicable)

 

5F

 

 

 

SS# / TIN

 

 

 

 

Internal Use Only

 

Borrower Financial and Ownership Information

 

 

Annual Income:

 

Liquid Assets:

 

Is the Borrower an officer or member of the board of directors of

 

 

 

 

UBS AG, its subsidiaries or affiliates?*

Net Worth

 

Fiscal Year End (indicate month)

 

o  Yes  o  No    If yes, please specify:

 

 

 

 

 

 

 

 

 

 

 

Subsidiary or Affiliate

 

Employee Name and SS#

Do you receive a substantial amount of your revenue/wealth

 

 

(over 50%) (trade/export) from a country outside of the United States?

 

Is the Borrower an immediate family member of an executive officer or

o  Yes  o  No    If yes specify:

 

member of the board of directors of UBS AG? Immediate family member

 

 

means a spouse or any other relative residing in the Borrower’s

Country(ies):

 

household to whom the Borrower lends financial support.

 

 

o  Yes  o  No    If yes, please specify:

Does the Borrower own 10% or more of the shares of any publicly

 

 

 

 

traded company?

 

 

 

Subsidiary or Affiliate

 

Employee Name and SS#

o  Yes  o  No    If yes, please specify company and %:

 

 

 

 

 

%

 

Will any of the loan proceeds be used to repay any debt or obligation owed

 

 

 

 

to, or purchase an asset from, UBS AG or its subsidiaries or affiliates?

 

 

 

 

o  Yes  o  No    If yes, please specify:

Are any of the Borrowers, business owners or directors/principal

 

 

officers a control person of UBS AG or its subsidiaries or affiliates?*

 

Subsidiary or Affiliate

o  Yes  o  No    If yes, please specify company and %:

 

 

 

 

 

%

 

 

 

*For purposes these questions, “control” means a person or entity that either (a) owns, controls or has the power to vote 25% or more of any class of voting securities, (b) has the ability to control the election of the majority of the directors of a company, or (c) has the power to exercise a controlling influence over management policies. A person or entity is presumed to have control of a company if the person or entity owns, controls or has the power to vote 10% or more of any class of voting securities of the company and (i) the person is an executive officer or director of the company or (ii) no other person has a greater percentage of that class of voting securities.

 

Principal Officer/Beneficial Owner

 

Complete this section for the Principal Officer(s) of the borrower, or beneficial owner for an LLC. To include additional principal officers please photocopy this page and submit it with the application.

 

Principal Officer Name

SS#

 

 

Principal Officer Name

SS#

 

 

 

 

 

 

Country of Citizenship:

 

Date of Birth

 

Country of Citizenship:

 

Date of Birth

 

 

 

 

 

o   USA

o   

Other (specify)

 

o   USA

o   

Other (specify)

 

Passport/CEDULA and Green Card#: (If non-U.S. and no SS# specified)

 

Passport/CEDULA and Green Card#: (If non-U.S. and no SS# specified)

 

/

 

 

 

/

 

 

Passport/CEDULA Country of Issuance:

 

Passport/CEDULA Country of Issuance:

 

 

 

Street Address:

 

Street Address:

 

 

 

City:

State:

ZIP

 

City:

State:

ZIP

 

 

 

 

 

 

 

Telephone Number:

 

 

Telephone Number:

 

 

HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

 

Ó 2008 UBS Bank USA. All rights reserved.

 

 

Sign and date the application on page 4

 

2



 

UBS Bank USA

Variable Credit Line Account Number: (if applicable)

5V

 

 

Fixed Credit Line Account Number: (if aaplicable)

 

5F

 

 

 

SS# / TIN

 

Credit Line Account Features

 

 

Internal Use Only

Check Writing

 

Alternate Mailing Address for Checks

If you would like to receive Credit Line checks for your credit line account, please enroll below:

 

Print the mailing address for the delivery of checks if different from the

 

address on the checks:

 

 

 

o   Check here if you would like Credit Line checks.

 

 

Checks will be in the name of the Borrower.

 

 

Please print the address that you would like to appear on your checks.

 

Wire Instructions for Loan Payment: (In US Dollars)

 

 

Bank Name: UBS AG

 

 

Wire System Address: ABA 026007993

 

 

 

 

 

For Further Credit to the Account of: UBS Bank USA

 

 

Account Number: 101-WA-792479-000

 

 

 

 

 

For the Benefit of: Full Name

 

 

Account Number: 5[F or V] 00000

 

Senior Political Affiliation

 

Are you, any authorized signatories, beneficial owners, trustees, powers of attorney or other individuals with authority to effect transactions, or any of their immediate family members or close associates a:

 

I)

Current U.S. political official (as defined in section B below)?              o No       o Yes;    complete:

 

 

A) Political Official’s Name:

 

 

 

 

 

B) Current Position:

o President

o Vice President

o US Cabinet Member

 

 

 

 

 

 

o Speaker of the House of Representatives

o Supreme Court Justice

 

 

 

 

 

 

o Chairman of the Joint Chiefs of Staff

o Ambassador

 

 

 

 

 

 

C) Relationship to Client(s):

o Self

o Immediate family member

o Close associate

 

 

 

 

 

 

 

o Associates with business or trust

 

 

 

 

 

II)

Current or former Senior non-U.S. political official, non-U.S. Religious Group/Organization, or Senior/Influential representative of a non-U.S. Religious Group/Organization?

o No   o Yes;    complete:

 

 

 

 

 

Political Official’s Name:

 

 

 

 

 

Current or Former Position:

 

 

 

 

 

Relationship to Client(s):

o Self

o Immediate family member

o Close associate

 

 

 

 

 

 

 

o Associates with business or trust

 

 

Duplicate Party Addendum

Complete this section for each Duplicate Party to receive a duplicate credit line account statement.

 

 

 

Internal Location Code (UBS Financial Services Inc. Use Only)

Name:

 

Country of Citizenship:

 

 

o

USA

o

Other (specify):

 

Street Address:

 

City:

State:

 

Zip:

 

 

 

 

 

 

 

 

 

 

Additional Address Information
If your mailing address is a P.O. Box please provide a residential street address below:

 

 

 

First Name:

 

Last Name:

 

Street Address:

 

 

 

 

 

Location of Address:

 

 

 

 

o     Business - Primary

 

 

 

 

o     Business - Secondary

 

 

 

City:

State:

 

ZIP:

 

 

 

 

 

 

 

 

 

o     Other (specify)

 

 

 

 

 

 

 

 

 

HB Rev 07/08 HB LOAD SPEDOC UX E HB V102

 

Ó 2008 UBS Bank USA. All rights reserved.

 

 

Sign and date the application on page 4

 

3