Brokerage and Non-Brokerage Accounts Asset & Financial Planning Account Application Account Number Social Security Number (required) Account Type (please check all that apply) Individual Pension Keogh 403(b) Non Existing Joint Profit Sharing IRA NFS New Other 1.) Account Information Client First MI Last Name Street Apartment Taxpayer ID No. City State Zip Code/Postal Code of Birth Telephone No. (Home) Telephone No. (Business) Representative Name Rep Number The above-named sales representative, (including solicitor and if applicable, the Broker/Dealer or Registered Investment Adviser with whom solicitor is affiliated) act as sales representatives for Asset & Financial Planning s ( AFP ) investment advisory services. Otherwise, the sales representatives are not affiliated with AFP. The sales representatives have a financial interest in the selection of AFP in that they may receive a portion of the fees payable by the client to AFP on a continuing basis. AFP reserves the right to re-assign the above-named sales representative. Such re-assignment shall not constitute an assignment as contemplated by the Investment Advisers Act of 1940. It is agreed that the following Family of Funds be utilized: Variable Annuity/Mutual Fund Company Share Type 2.) Contract Execution Investor, by execution of this Application, hereby acknowledges concurrent receipt of AFP Contract Disclosure Statement containing information recently filed with the Securities and Exchange Commission. IN WITNESS THEREOF, the parties have executed the Contract and Application. Signature of Client Signature of Joint Client Signature of IAR of Asset & Financial Planning, Ltd. 1
Brokerage and Non-Brokerage Accounts Asset & Financial Planning Account Application The following must be completed by Representative: Source of Assets: Cash Yes No $ Existing Yes No $ Transfer Yes No $ Please indicate below the Account Number from which Transfer is to be made: Account Number Is AFP to process liquidation / transfer / journal? Yes No If yes, please include the following: AFP Account Number from which money is coming: AFP Account Number to which money is going: Choose one of the following: Total Amount to be Liquidated to Money Market: Total Amount to be Journaled: Systematic Withdrawal Yes No Number of Withdrawals Amount $ Withdrawal Yes No Withdrawal Amount $ Periodic Investment Yes No Number of Investments Amount $ Additional Deposit Yes No Deposit Amount $ Remove from AFP Yes No Effective Comments Representative Signature Rep No. 2
Brokerage Accounts Management Fee Deduction Authorization Please read this authorization carefully before signing. To: National Securities Corporation. (NSC) This authorization directs NSC to deduct management fees from my account. I have separately authorized a representative of Asset & Financial Planning, Ltd. ( Representative ) to be my Representative to buy or sell securities and other investments for my account. I understand that my account will be charged a management fee as determined and directed by my Representative which will be a specified percentage of the total market value of my account. This fee shall be calculated on the last calendar day of each month and charged to my account by NSC at the beginning of each month. The fee schedule applicable to my account has been provided to me by my Representative under separate cover. This authorization directs NSC to deduct the fees from the account specified below. I will indemnify and hold NSC and its directors, officers, employees and control persons harmless from all liabilities and costs, including attorney fees, which you may incur by acting in reliance upon this authorization. However, nothing herein shall constitute a waiver or limitation of any right which you may have under any Federal or State securities law. This authorization will remain in full force and effect until revoked by me in a written notice delivered personally or sent by registered or certified mail to your office. This authorization shall extend to the benefit of your successors and assigns. I understand that revocation of this authorization could result in the termination of this account. Account Number Signature of Client Name of Client (please print) Signature of Joint Client Name of Joint Client (please print) Signature must be guaranteed in the space below by a U.S. commercial bank or a member firm of a national securities exchange. 3
Brokerage Accounts Trading Authorization Limited to Purchase and Sales of Securities The undersigned hereby authorizes Asset & Financial Planning, Ltd., (AFP), whose signature appears below, as his/her agent and attorneyin-fact with limited trading authorization, power and authority to sell (including short sales), purchase, exchange, convert, tender, trade or otherwise acquire or dispose of stocks, bonds, and other securities including the purchase and/or sale of option contracts (exchange/change traded or over-the-counter, puts, call, etc.) to open new option positions or close existing positions, to exercise option contracts and to sell option contracts as either a covered or uncovered writer, and/or contracts relating to the same on margin or otherwise in accordance with your terms and conditions for the undersigned s account and risk in the undersigned s name and/or number on your books. The undersigned hereby agrees to indemnify and hold you harmless from and to pay you promptly on demand any and all losses arising therefrom or debit balance due thereon. In all of the above described transactions, you are authorized to follow the instructions of Asset & Financial Planning, Ltd. in every respect concerning the undersigned s account with you; and AFP is authorized to act for the undersigned and in the undersigned s behalf in the same manner and with the same force and effect as the undersigned might or could do with respect to the aforementioned transaction as well as with respect to all other things necessary or incidental to the furtherance or conduct of such purchase, sales, or transactions. The undersigned hereby ratifies and confirms any and all transactions with you heretofore or hereafter made by the aforesaid agent or for the undersigned s account. I acknowledge that I have authorized my agent and attorney-in-fact to engage in option transactions. I recognize that due to the short term nature of options, you may be trading options to a greater degree than stocks or bonds. In that connection, I understand that I will be charged a commission each time a trade is effected. I further understand that option trading has a number of inherent risks connected therewith and I am fully prepared financially to undertake such risks. This authorization and indemnity is in addition to (and in no way limits or restricts) any rights which you may have under any other agreement or agreements between the undersigned and your firm. Nothing in this agreement will waive or limit any rights that you may have under Federal or State Securities laws. This authorization and indemnity is also a continuing one and shall remain in full force and effect until revoked by the undersigned by a written notice addressed to you and delivered to you at 11 Raymond Avenue, Poughkeepsie, New York but such revocation shall not effect any liability in any way resulting from transaction initiated prior to such revocation. This authorization and indemnity shall inure irrespective of any change or changes at any time in the personnel thereof for any cause whatsoever. Client Signature Address City State Zip Signature must be guaranteed in the space below by a U.S. commercial bank or a member firm of a national securities exchange. Asset & Financial Planning, Ltd. Signature of IAR of Asset & Financial Planning, Ltd. Name of IAR of Asset & Financial Planning, Ltd. (please print) 4
Non-Brokerage Accounts Initial Management Fee Deduction Authorization Asset & Financial Planning, Ltd. Registered Investment Adviser 11 Raymond Avenue, Poughkeepsie, NY 12603 (845) 485 2220 tel (845) 485-4065 fax ACCOUNT # NAME ADDRESS TO: TO WHOM IT MAY CONCERN: Please accept this letter as your authorization to immediately liquidate a sufficient number of shares in the above referenced account to amount to $ (This amount is calculated in the Home Office when the account is established, as follows: Market Value of account multiplied by fee% divided by 365 multiplied by the remaining days in the Quarter). THIS IS NOT A TOTAL LIQUIDATION. Do not withhold taxes. This is a management fee not subject to withholding. According to letter ruling 8951010 (18 September 1989) and subsequent ruling 30 August 1990; revenue ruling 84-146 provides that amounts paid by a retirement plan owner for management fees in connection with that retirement plan are separately deductible under section 212 of the code as a trust expense to the extent that they satisfy the requirements of that section. In addition, according to the 30 August 1990 ruling, Direct payments from the accounts as described above are not distributions within the meaning of section 403(b)(1). Ruling 8951010 states that this payment should not be included in gross income under section 408(d) (1), and would not be subject to the additional tax under section 72(t). Please remit check for this amount made payable to: And mail the check to: ASSET & FINANCIAL PLANNING, LTD. Asset & Financial Planning, Ltd. 11 Raymond Avenue Poughkeepsie, NY 12603 Please note: This request must be properly signed and guaranteed. Signature of Client Signature of Joint Client Your signature must be guaranteed in the space below by a U.S. commercial bank or a member firm of a national securities exchange. 5
Non-Brokerage Accounts Exchange/Transfer and Fee Redemption Authorization Asset & Financial Planning, Ltd. Registered Investment Adviser 11 Raymond Avenue, Poughkeepsie, NY 12603 Tel: (845) 485-2220 Fax: (845) 485-4065 INVESTOR authorizes COMPANY or its transfer agent to establish a periodic withdrawal equal to _ the below referenced accounts on the last business day of the month or quarter as applicable. of the total asset value in This authority will continue until COMPANY receives written notice of termination from INVESTOR. Account Registration Account Number The undersigned shareholder(s) ( INVESTOR ) hereby appoints Asset & Financial Planning, Ltd., herein referred to as AGENT, as his true and lawful attorney and agent to execute certain transactions as described herein with full power and authority to act in his place and stead with the same effect as if he had done the same himself, and specifically to execute orders to sell and purchase shares of the funds within the above-named COMPANY, and to exchange and/or transfer the assets of the above-referenced Managed Accounts. Such authority shall be continuing and shall extend to any account established by exchanging and/or transferring the assets of the Managed Accounts. The COMPANY accepting such orders shall not be required to inquire into the basis of such exchanging and may accept such orders of said AGENT without any other inquiry. INVESTOR understands that the COMPANY, its investment Advisers, transfer agents, and distributors are not involved in any way in the selection of the funds in these exchanges/transfers or in the timing of the exchanges. INVESTOR agrees to hold said COMPANY, its investment adviser representatives, transfer agents, and distributors harmless from any claims arising from the selections of the funds or the timing of the exchanges, including all investments made in these funds by INVESTOR prior to and subsequent to signing this Limited Power of Attorney. INVESTOR agrees that the AGENT shall not be liable for anything done or omitted by the AGENT under this Agreement so long as the AGENT shall not have acted in fraud, bad faith, or willful misconduct. This Power of Attorney may be relied on as being in full force and effect until notice of revocation by certified mail to the COMPANY. Do not withhold taxes. This is a management fee not subject to withholding. According to letter ruling 8951010 (18 September 1989) and subsequent ruling 30 August 1990, revenue ruling 84-146 provides that amounts paid by a retirement plan owner for management fees in connection with that retirement plan are separately deductible under section 212 of the code as a trust expense to the extent that they satisfy the requirements of that section. In addition, according to the 30 August 1990 ruling, Direct payments from the accounts as described above are not distributions within the meaning of section 403(b) (1). Ruling 8951010 states that this payment should be not included in gross income under section 408 (d) (1), and would not be subject to the additional tax under section 72(t). Please remit check for this amount made payable to: And mail the check to: ASSET & FINANCIAL PLANNING, LTD. Asset & Financial Planning 11 Raymond Avenue Poughkeepsie, NY 12603 Signature of Client Name of Client (please print) Signature of Joint Client Name of Joint Client (please print) 6
Brokerage and Non-Brokerage Accounts Ongoing Portfolio Management Agreement Asset & Financial Planning, Ltd. Registered Investment Adviser 11 Raymond Avenue, Poughkeepsie, NY 12603 Tel: (845) 485-2220 Fax: (845) 485-4065 This AGREEMENT is entered into this day of, 20 by and between, ( Client ) and Asset and Financial Planning, Ltd., ( Adviser ) an SEC registered investment advisory company. In consideration of the mutual benefits to be derived from this Agreement, it is understood and agreed as follows: 1.) SERVICES OF ADVISER: The Adviser through consultation or a prepared financial plan will assist the Client in defining financial planning goals and objectives to be pursued in the applicable areas of personal financial planning, business planning, insurance and estate planning, and investments. The Adviser will supply analysis and specific recommendations as to what financial decisions and investment strategies are necessary for the client to attain his/her goals and objectives. In addition, the Adviser will provide specific investment recommendations and ongoing portfolio management and reporting to assist the Client in attaining his/her specifically defined goals and objectives. On a discretionary basis, AFP may, from time to time, engage sub-managers to provide various investment advisory or investment Adviser related services to Client. The Adviser may also recommend products or services managed or offered by other investment advisers or other parties (third parties) that may or may not be affiliated with the Adviser. Such products or services may include, but would not be limited to, separately managed account programs as well as wrap fee programs. A Separately Managed Account Program is essentially a traditional brokerage account managed by an investment adviser. In the context of the Adviser s Services, the Adviser may refer its clients to outside investment advisers who would perform specific investment advisory or portfolio management services over clients accounts. The Adviser may recommend outside investment advisers to perform such services for its clients accounts and in turn, the Adviser will monitor such outside investment advisers performance with respect to such separately managed account programs. Specific services and fees related to such programs will be available in the outside investment adviser s current disclosure document(s). A Wrap Fee Program is a program that offers participants a suite of services such as asset allocation, portfolio management, trade execution, and certain administration activities, all for a single fee typically an annual percentage of the client s total assets under the investment adviser s management. A Wrap Fee program(s) is designed to assist clients in obtaining professional asset management services for a convenient single wrapped fee. The Adviser serves as the principal sponsor of its wrap program. The Adviser shall offer a wrap fee brochure or other appropriate discloser document to any advisory clients who are recommended to participate in a wrap program(s). The wrap fee brochure provides clients with disclosure information about the wrap fee program itself. The Adviser shall also provide a copy of current disclosure document for the specific investment manager(s) selected to manage a client s assets in a wrap program(s). A wrap program participant should consider all of the information inside the wrap fee brochure and the selected investment manager s disclosure document before participating in a wrap fee program recommended by the Adviser. 2.) CLIENT S RESPONSIBILITY: The Client recognizes that the value and usefulness of the financial planning services of the Adviser will be dependent upon information that he/she provides and upon his/her active participation in the formation of financial planning objectives and in the implementation of the plan to attain these objectives. The Client will provide copies of insurance policies, wills, tax returns, investment statements and other documents as may reasonably be requested in order to evaluate and prepare recommendations to the Client. For ongoing Portfolio Management and Reporting, the fees (see below) will be determined by the schedule in force at the time of contract services and will include Quarterly Consolidated Statements, an Annual Review Meeting, unlimited telephone support and ongoing Investment Advisory recommendations. Schedule of Annual Fees Asset Value Annual Fee 0 to % Equities Schedule of Ticket Charges $26.00 +$0.02 a share for transactions over 3,099 to % Fixed Income $35.00 Over % Monthly Quarterly Mutual Funds Load Funds $26 No Load Funds $26 (except NTF) Other 7
The Client or Adviser may terminate the contract by writing either party at any time. The Client may terminate this agreement within 5 business days without penalty. 3.) MISCELLANEOUS: Client(s) agree that the Adviser shall not be liable for acts or omissions by the Adviser under this Agreement so long as the Adviser shall not have acted in fraud or willful misconduct. However, nothing herein shall constitute a waiver or limitation of any right which the client may have under any Federal or State securities law. The Client acknowledges that he/she understands that the individual soliciting this account is a Registered Representative licensed with National Securities Corporation, a Registered Broker/Dealer, and also holds licenses with several insurance companies. If the Client executes investment transactions through the Registered Representative, National Securities Corporation, Inc. may receive commissions and the Registered Representative may share in those commissions. If the Client has cause to purchase or exchange any insurance products, the Planner may receive commissions. In addition, the Representative of the Adviser will receive a portion of all of the fees paid on this Agreement. This Agreement may not be amended, transferred, assigned, sold, or in any manner hypothecated or pledged by either party. The Clients also acknowledges that he/she has been advised and understands that, in the event he/she chooses to implement any recommendations made by Asset and Financial Planning, Ltd., the Client is not required to do so through National Securities Corporation. All opinions, advice, recommendations, or suggestions are based on information and research derived from original or published sources believed to be accurate and reliable, but recognized as not infallible. This Agreement and the transactions under it shall be governed and interpreted in accordance with the laws of the State of New York applicable to the contracts made and to be performed, the Investment Advisers Act of 1940 and the rules and regulations promulgated thereunder. 4.) DISCLOSURES: By checking the boxes below, the Client acknowledges that he/she understands and has received the appropriate documents or information: The Client(s) acknowledge that they have read this contract and that they have received a copy of Part II of Asset and Financial Planning, Ltd. s Form ADV and/or a brochure containing information relating to the investment Adviser and the nature of its business; The Client(s) acknowledge that, if over the age of 65, the option to have a trusted family member or personal representative present during sales presentations or account review meetings where the purchase of investment advisory services was discussed; The Client(s) acknowledge that at least three (3) money management platforms/programs were presented to choose from: (please list here),,. IN WITNESS WHEREOF the parties have executed this AGREEMENT the day of the year aforesaid intending to be legally bound hereby. Client Signature Client Name (please print) Joint Client Signature Joint Client Name (please print) AGREED AND ACCEPTED BY: ASSET AND FINANCIAL PLANNING,LTD. Signature of Agent of Portfolio Manager Name of Agent of Portfolio Manager (please print) 8
Asset & Financial Planning, Ltd. To be completed by Rep: Account Number: Account Name: Investment Manager: Investment Objective/Style: Restrictions: No: Yes: If Yes, Describe: Monthly Distribution/Contribution: No; Yes: Description: To be Completed by Money Manager: Investment Manager Accept: Reject: Firm Name: Officer: Signature: Title: : 9
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