Other Fees (when applicable)

By completing the information and signing below, I attest that I have accurately provided the name, address, date of birth, and Social Security Number, (SSN) for the following individual, (i.e. the Controlling Position):

(i) An Individual with significant responsibility for managing the legal entity customer (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Director, Officer, or Treasurer.)

NOTE: THE INFORMATION PROVIDED BELOW ARE USED TO VALIDATE THE CONTROLLING PERSON. NO CREDIT CHECK WILL BE PERFORMED.

Full Name:   abc
Home Address:  
Date of Birth:  
Social Security Number:  

I, the undersigned    , certify that all the information furnished above with regard to information for the "Controlling Position" listed above is complete and accurate.

Signature:  

Date: