Secure CD Application – Secure Application

1. Account Type & Primary Applicant Information

Account Ownership Type

Individual Joint Tenants (JTWROS) Payable on Death (POD)

Primary Applicant

Legal First Name

Legal Middle Name

Legal Last Name

Date of Birth

Social Security Number (SSN)

Citizenship

Residential Street Address

City

State

Zip Code

Email Address

Mobile Telephone

2. Joint Applicant Information

⚠️ If you selected “Individual” for Account Ownership Type in Section 1, please leave this entire section blank.

Legal First Name

Legal Last Name

Relationship to Primary

Date of Birth

Social Security Number (SSN)

Citizenship

Residential Street Address (if different from Primary)

City

State

Zip Code

Email Address

Mobile Telephone

Joint Applicant Financial & Employment Details

Annual Income

Total Net Worth (excluding primary residence)

Occupation / Job Title

Employment Status

3. Primary Applicant: Financial Profile & Suitability

Annual Income

Total Net Worth (excluding primary residence)

Liquid Net Worth (cash & marketable securities)

Primary Investment Objective

Investment Experience (Years)

Risk Tolerance

4. Primary Applicant: Employment & Source of Funds

Occupation / Job Title

Employment Status

Primary Source of Deposit Funds

5. Identity Verification (CIP/KYC)

To comply with federal Customer Identification Program requirements, please upload clear, color scans. If Joint, please upload documents for both applicants.

Primary Applicant: Government-Issued ID (Passport or Driver’s License)

Primary Applicant: Proof of Address (Utility bill or bank statement < 90 days)

Joint Applicant: Government-Issued ID (If applicable)

Joint Applicant: Proof of Address (If applicable)

6. CD Selection & Funding

Select CD Term

Deposit Amount (USD)

Preferred Funding Method

Minimum deposit $50,000. Must be in increments of $10,000.

External Bank Routing Number (if ACH)

External Bank Account Number (if ACH)

Maturity Instructions

Return principal and final interest to my nominated bank account. Renew my CD subject to the bank’s renewal terms and prevailing rates. Contact me before maturity for further instructions.

7. Tax Certification (IRS Form W-9)

Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number; and (2) I am not subject to backup withholding.

I certify that my Taxpayer Identification Number (TIN/SSN) provided above is correct. I certify that I am a U.S. citizen or other U.S. person (as defined by the IRS). I certify that I am not subject to backup withholding.

8. Regulatory Disclosures & Agreements

FDIC Insurance & Firm Status: Each CD is a direct obligation of the Issuer and is not, either directly or indirectly, an obligation of the Firm. The Firm (UBS Financial Services Inc.) is not an FDIC-insured depository institution. Your deposits, including your CDs, at each Issuer are insured by the FDIC up to $250,000 (including principal and accrued interest) for all deposits held in the same insurable capacity at the Issuer.

SIPC Protection: UBS Financial Services Inc. is a registered broker-dealer and a Member of the Securities Investor Protection Corporation (SIPC), which protects securities customers of its members up to $500,000 (including $250,000 for claims for cash). Member FINRA.

Fees: The Firm and the broker-dealer arranging for the CD to be offered will receive a placement fee from the Issuer of up to 30 basis points (0.30%) per annum of the principal amount of CDs purchased by you in the primary market.

Secondary Market & Premiums: If you purchase a CD in the secondary market at a premium over the par amount, that premium is not insured by the FDIC. Therefore, if deposit insurance payments become necessary for the Issuer, the owner of a CD purchased in the secondary market can incur a loss of up to the amount of the premium paid.

Call Feature: Some CDs may be subject to redemption on a specified date or dates at the sole discretion of the Issuer (a “call” feature). If the CD is called, you will be paid the outstanding principal amount and interest accrued up to, but not including, the call date.

Arbitration Agreement: By opening this account, you agree that any controversy or claim arising out of or relating to this account or the services provided shall be settled by arbitration in accordance with the rules of FINRA.

Privacy Notice: We collect nonpublic personal information about you from applications and transactions. We do not disclose this information to nonaffiliated third parties except as permitted by law.

I have read, understand, and agree to the Account Agreement, CD Disclosure Statement, and Arbitration Agreement. I provide my electronic consent to receive all disclosures, statements, and notices electronically (E-Sign Act).

9. Application Declaration & E-Signature

By signing below, I declare that the information provided is true and complete. I authorize the Firm to open this account on my behalf and verify the information provided.

Primary Applicant Signature

Printed Full Legal Name

Date

Electronic Signature

Joint Applicant Signature (If Applicable)

⚠️ If you selected “Individual” for Account Ownership Type in Section 1, please leave this signature block blank.

Printed Full Legal Name

Date

Electronic Signature

Certificate of Deposit Account Application