Individual Account Application » Univest Securities

Select Your Registered Representative (Broker) *

Account Setup

Account Types *IndividualJoint

Tenants with Right of SurvivorshipTenants in Common Tenants by the Entirety Community Property

Account Features *CashMarginOption

Account Name *

Personal Information For Primary Account Holder

Last Name *

First Name *

Residence Address (Street Address - No P.O. Boxes Allowed) *

City *

State/Province *

ZIP / Postal Code *

Country

Social Security Number (if applicable) *

Number of Dependents *

Date of Birth *

Marital Status *MarriedDivorcedSingle

Cell Phone *

Email Address *

Your Country of Citizenship *

Drivers License #, Passport # or Alien Identification Card # (if applicable) *

Employment Information and Affiliations

If employed, please state the name and address of your employer and the nature of the business. If you are self-employed, provide the name of your business and industry. If retired, please list your last position.

Employer *

Position/Title *

Address of Employer (city, state and country) *

Describe Your Nature of The Business *

Interest in a Public Company

Please check the appropriate box(es) below and indicate ticker symbol(s) if you, or any member of your immediate household, are associated with a public company, whether US or non-US, in one or more of the following capacities

Executive Officer*An executive officer is defined as a company’s president, any vice president in charge of a principal business unit, division or function (such as sales, administration or finance), any other officer who performs a policy making function, or any other person who performs similar policy making function for the company. If you are not sure whether you are an executive officer, please consult with your company’s in-house counsel.

Director

10% Shareholder

5% Sharehold

If not employed, state reason

Suitability and Account Holder

Liquid Net Worth in U.S. Dollars: Exclude the value of your real estate and other illiquid assets *Below $50,000$50,000 - $149,999$150,000 - $499,999$500,000 - $999,999$1,000,000 - $4,999,999$5,000,000+

Total Net Worth of All Assets in U.S. Dollars: Total assets mi-nus total liabilities *Below $50,000$50,000 - $149,999$150,000 - $499,999$500,000 - $999,999$1,000,000 - $4,999,999$5,000,000+

Liquidity Needs: The ability to quickly and easily convert to cash all or a portion of the investments in this account without experi-encing significant loss in the value from, for example, the lack of a ready market, or incurring significant costs or penalties is *Very importantSomewhat importantImportantDoes not matter

Are you an “Accredited Investor?” *YesNoAn Accredited Investor is a person whose individual net worth, or joint net worth with a spouse, is over $1 million (excluding the value of your primary residence) or who had an individual income in excess of $200,000 in each of the two most recent years, or joint income with a spouse in excess of $300,000 in each of those years and reasonably expects to reach the same income level in the current year.

Are you a “Qualified Client?” *YesNoA Qualified Client is a person who has at least $1,100,000 under management with an SEC registered investment advisor or individual net worth in excess of $2,200,000.

Tax Rate *

Investment Experience *NoneLimitedGoodExtensive

Investment Objectives *Preservation of CapitalIncomeCapital AppreciationSpeculation- Preservation of Capital: An investment objective of Preservation of Capital indicates you seek to maintain the principal value of your investments and are interested in investments that have historically demonstrated a very low degree of risk of loss of principal value.
- Income: An investment objective of Income indicates you seek to generate income from investments and are interested in investments that have historically demonstrated a low degree of risk of loss of principal value.
- Capital Appreciation: An investment objective of Capital Appreciation indicates you seek to grow the principal value of your investments over time and are willing to invest in securities that have historically demonstrated a moderate to above average degree of risk of loss of principal value to pursue this objective.
- Speculation: An investment objective of Speculation indicates you seek a significant increase in the principal value of your investments and are willing to accept a corresponding greater degree of risk by investing in securities that have historically demonstrated a high degree of risk of loss of principal value to pursue this objective.

Time Horizon (Check one) *Short-TermIntermediateLong-Term

Risk Tolerance (Check one) *ConservativeModerateAggressiveSpeculative- Conservative: You want to preserve your initial principal in this account, with minimal risk, even if that means this account does not generate significant income or returns and may not keep pace with inflation.
- Moderate: You are willing to accept some risk to your initial principal and tolerate some volatility to seek higher returns, and understand you could lose a portion of the money invested.
- Aggressive: You are willing to accept high risk to your initial principal, including high volatility, to seek high returns over time, and understand you could lose a substantial amount of the money invested.
- Speculative: You are willing to accept maximum risk to your initial principal to aggressively seek maximum returns, and understand you could lose most, or all, of the money invested.

Are you in any direct or indirect ownership by any Politically Exposed Person (“PEP”)? *YesNoa Politically Exposed Person is someone who, through their prominent position or influence, is more susceptible to being involved in bribery or corruption.

Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker-dealer?(if “yes,”please attach a letter from your employer approving the establishment of your account when submitting this application) *YesNo

Have you ever been the subject of a bankruptcy proceeding, receivership, or similar action? *YesNo

Funding of Account

Initial Funding Amount $ *

Other *

Trusted Contact Person

Name

Phone

Address

City

State/Province

ZIP / Postal Code

Country

Email Address

Relationship to Account Holder

Date of Birth (must be over 18)

Web Site Access and Online Delivery Consent

View account information through the use of electronic services (Recommended)

Trade through the use of electronic services, to the extent available (For non-discretionary brokerage accounts only)

I hereby authorize Velox to e-mail to me (Check all that apply) *Trade confirmations**Monthly account statements**Prospectuses, proxy materials, annuals reports, disclosure documents and other communications***

BY SIGNING ABOVE AGREEMENTS, I (WE) ACKNOWLEDGE THE FOLLOWING: (1) THE CUSTOMER ACCOUNT AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE AND IN ACCORDANCE WITH THIS AGREEMENT I (WE) AGREE IN ADVANCE TO ARBITRATE ANY CONTROVERSIES WHICH MAY ARISE BETWEEN OR AMONG ME (US), MY BROKER, AND/OR CLEARING FIRM; (2) RECEIPT OF A COPY OF THE THIS CASH ACCOUNT OPENING AGREEMENT, AND CUSTOMER MARGIN AND SHORT ACCOUNT AGREEMENT; (3) THE INFORMATION PROVIDED ABOVE IS ACCURATE; (4) IF I DO NOT BORROW MONEY IN THE MARGIN ACCOUNT, I WILL NOT BE CHARGED INTEREST.

THOES ARE CONTRACTUAL AGREEMENT. DO NOT SIGN BELOW UNTIL YOU HAVE READ THIS AGREEMENT CAREFULLY.

Print Your Name (Account Holder, Trustee, Custodian or Executor) *

Your Signature *

Date *

Print Name of Additional Account Holder *

Additional Account Holder Signature *

Date *

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