[$J.

Wealth Management
U.S. Bancorp Investments
INSTRUCTIONS

 You must submit the notarized Power of Attorney document which declares the Attorney-in-Fact.

Sec. 1 Enter your name, check the type of account you are putting the Power of Attorney on, and enter your Social Security number and
U.S. Bancorp Investments, Inc., account numbers to which this applies.

Sec. 2
• Enter all requested information about the person you are naming as your Attorney-in-Fact “AIF”.
a) Indicate whether the POA document is a durable or non-durable POA. This should be spelled out near the beginning of the POA document
you have.
b) Enter the date of your POA and any expiration date.
c) Enter your name as the Principal.
• Now enter all requested information about your Attorney-in-Fact “AIF”.

Sec. 4 Your Attorney-In-Fact must sign and date the form.

Sec. 5 If there are joint owners on this account: Each one of them must print their name, sign, and date the form to indicate they are aware of the
Power of Attorney being placed on the account. NOTE: If any joint owner refuses to sign this document, the POA request cannot be honored.

Investment and insurance products and services including annuities are: NOT A DEPOSIT • NOT FDIC INSURED •
MAY LOSE VALUE • NOT BANK GUARANTEED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY
Investment and insurance products and services including annuities are available through U.S. Bancorp Investments, the marketing name for
U.S. Bancorp Investments, Inc., member FINRA and SIPC, an investment adviser and a brokerage subsidiary of U.S. Bancorp and affiliate of U.S. Bank.
Insurance products are available through various affiliated non-bank insurance agencies, which are U.S. Bancorp subsidiaries.
Products may not be available in all states. CA Insurance License# 0E24641.
PERSONAL
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 [$J.Wealth Management POWER OF ATTORNEY AFFIDAVIT
AND INDEMNIFICATION
U.S. Bancorp Investments

070

• Not valid without notarized POA document provided by client.

• U.S. Bancorp Investments, Inc., does not provide blank Power of Attorney forms.
• If this is for a joint account, all account owners not named in the POA must sign this U.S. Bancorp Investments form before submitting to
U.S. Bancorp Investments.
• A POA document which states it does not go into effect until some triggering event (such as the principal becoming incapacitated) cannot be
accepted by U.S. Bancorp Investments unless the event has occurred. Acceptable written proof that this event has occurred must be submitted
with this POA Affidavit and Indemnification form and the principal’s notarized POA document.
• If the Attorney-in-Fact cannot act independently of any other AIFs on the account, this request to add a POA cannot be honored.

1 Account Information
Primary Account Owner SSN/TIN Accounts to Which This POA Applies.

1. ________________ 4. ________________

Representative Name Rep ID

I Representative Phone
11 2. ________________ 5. ________________

3. ________________ 6. ________________

2 Power of Attorney (“POA”); Principal; Attorney-In-Fact (“AIF”) Information (Continued on page 2.)
POA Type Date of POA Expiration Date (If any) n None (default) Name of Principal (Person giving the power)

n Non-durable POA ________ / ________ / ________ ________ / ________ / ________

n Durable POA

ATTORNEY-IN-FACT

~---~~-~~-~I~~
Name of AIF (Person accepting the power.) Daytime Phone Number of AIF SSN of AIF Date of Birth of AIF
(10 digits)

Address of AIF (Cannot be a P.O. Box) City State ZIP Code

Citizenship of AIF Picture Identification

~---CII~
n U.S. citizen
n U.S. Driver’s license (State: _______ ) n U.S. State ID (State: _______ ) n U.S. Military Service ID
n Resident alien
n Nonresident alien n Passport (Country: _______________________ ) n U.S. Resident Alien/Immigration ID

Number on ID: _______________________________________ Expiration Date (mm/dd/yyyy): _____________________________

Investment and insurance products and services including annuities are: NOT A DEPOSIT • NOT FDIC INSURED •
MAY LOSE VALUE • NOT BANK GUARANTEED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY
Investment and insurance products and services including annuities are available through U.S. Bancorp Investments, the marketing name for
U.S. Bancorp Investments, Inc., member FINRA and SIPC, an investment adviser and a brokerage subsidiary of U.S. Bancorp and affiliate of U.S. Bank.
Insurance products are available through various affiliated non-bank insurance agencies, which are U.S. Bancorp subsidiaries.
Products may not be available in all states. CA Insurance License# 0E24641.
PERSONAL
Page 2 of 4 30494 (08/23) v1.0
 [$J.Wealth Management POWER OF ATTORNEY AFFIDAVIT
AND INDEMNIFICATION
U.S. Bancorp Investments

070

2 Power of Attorney (“POA”); Principal; Attorney-In-Fact (“AIF”) Information (Continued from page 2.)
Securities Industry Affiliation
NOTE: Immediate family is defined as any child, stepchild, grandchild; parent, stepparent, grandparent; spouse; sibling; mother-in-law, father-in-law, daughter-in-law,
son-in-law, brother-in-law or sister-in-law if living in the same household; includes adoptive relationships.

Are you or an immediate family member/domestic partner:

n Yes n No 1. A director, 10% shareholder or policy making officer of any publicly traded company? If yes: Symbol(s) _____________
n Yes n No 2. Employed by Financial Industry Regulatory Authority, a broker/dealer, investment advisor or other securities firm? If employed by a broker/
dealer other than U.S. Bancorp Investments: U.S. Bancorp Investments must receive written authorization from your employer authorizing
the opening of an account with U.S. Bancorp Investments.
n Yes n No 3. A senior officer of a bank, savings and loan, insurance company, registered investment advisory firm, registered investment company or a
person who could influence the trading of investments in an institutional type account?

If yes to any:
Name of Person:________________________________________________________ Relationship of this person to you: ___________________________________

Name of Firm/Employer: ________________________________________________ Address of Firm/Employer: __________________________________________

__________________________________________

PERSONAL
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 Primary Account Owner: _________________________________________
[$J.Wealth Management
U.S. Bancorp Investments
SSN/TIN: ________________ Account #: ________________________

070

3 Affidavit and Indemnification

To U.S. Bancorp Investments, Inc.: Â If the POA is not a Durable Power of Attorney, Principal has not
been declared incompetent or incapacitated nor is a petition to
I, being duly sworn, do hereby declare under penalties of perjury that
determine the competence or mental capacity of Principal pending;
the attached Power of Attorney/Durable Power of Attorney (the “POA”)
is in full force and effect and I affirm that: • I certify that I am fully authorized to act independently of any other
attorneys-in-fact named in the POA;
• I am the above-named AIF and I am designated in the POA as
an attorney-in-fact for Principal who is not deceased and was • I understand that if you receive conflicting instructions from me and
competent and not under any undue influence or duress at the time another attorney-in-fact and/or Principal relating to the Account, or
of the POA’s execution; instructions from any regulatory authorities, that you may restrict
some or all transactions in the Account until you have received, in
• I am authorized to conduct all activities in and relating to the
your sole discretion, satisfactory written resolutions of the conflict or
Account referenced in Section 1 above (the “Account”) on behalf of
issue, as applicable.
Principal, including the authorization to sign federal tax forms, and
no instruction from me relating to the Account will be prohibited by I understand that any information I give to you under this affidavit and
the POA, the Account terms and conditions or any applicable laws; indemnification is subject to verification and that you may, but are
not obligated to, verify its contents with independent sources. As an
• The POA has not been partially or completely revoked, terminated
inducement to you allowing me to act on behalf of Principal with respect
or suspended by Principal or through a legal proceeding, and I will
to the Account, I agree to fully indemnify and hold you, your parent,
promptly notify you of any revocation, termination or suspension of
affiliates, directors, officers, employees and agents harmless from
the POA or my authority thereunder;
and against any losses, liabilities, damages, claims or costs (including
• No guardian has been appointed over Principal and no petition for reasonable attorneys’ fees) arising from any transactions that I make or
guardianship is pending; authorize as the AIF for Principal.

 By signing below, I agree to be bound by the terms and conditions contained in the Customer Agreement which controls the account for which I
am Attorney-in-Fact.

Signed under penalty of perjury, ______________________________________________________________________________ ______________________

Signature of Attorney-In-Fact Date

4 Joint Account Owners’ Acknowledgment

• All account owners not named in the POA document are required to sign below.
By signing below, I acknowledge that I am aware that a Power of Attorney is being placed on this account by one of the other joint owners of the
account. I further acknowledge that the Attorney-in-Fact named in the POA may place transactions in the account and may remove or transfer funds
or assets from the brokerage account at any time without my knowledge or consent.

____________________________________________________ ____________________________________________________ ______________________

Print Name of Joint Owner Signature of Joint Owner Date

____________________________________________________ ____________________________________________________ ______________________

Print Name of Joint Owner Signature of Joint Owner Date

____________________________________________________ ____________________________________________________ ______________________

Print Name of Joint Owner Signature of Joint Owner Date

____________________________________________________ ____________________________________________________ ______________________

Print Name of Joint Owner Signature of Joint Owner Date

Instruction for U.S. Bancorp Investment Representative Only.

Submit via workflow, provide a copy to client. Original to branch file.

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 [!llWealth Management CLIENT WORKSHEET
FOR A PERSON
U.S. Bancorp Investments

CIP Notice: Read or show to client prior to gathering information.

To help the government fght the funding of terrorism and money laundering activities, federal law requires all fnancial CIP NOTICE
institutions to obtain, verify and record information that identifes each customer and person who opens an account.
What this means to you: When you open an account with U.S. Bancorp Investments, Inc., we will ask for your legal _______________________
name, address, date of birth and other information that will allow us to identify you. We will also ask to see your driver’s Date CIP Provided
license or other identifying document. If you are a non-person entity, we may ask for copies of certifed articles of incor- (mm/dd/yyyy)
poration, an unexpired government-issued business license, a partnership agreement or other documents that indicate h Oral h Written
the existence and standing of the entity.

1 Client 1 (If custodial: Put minor’s information in this section.) (Continued on page 2.)
Legal Name (First, Middle and Last) SSN/TIN Date of Birth

~-----~~--~I
Street Address of Residence (Cannot be a P.O. Box) City State ZIP
--
~----~--~-1~1
Mailing Address if Different From Residential Address City State ZIP
-­
~----~--~-1~1
Gender Marital Status Phone (10 digits) Alternative Phone (10 digits) Email Address
-- Number of Dependents
(As on your tax return.)
h Male h Married
h Female h Not Married

Citizenship/Residency Status. (For Non Resident Alien, complete the Non NAO Application.)
h U.S. citizen h Resident Alien/U.S. Permanent Resident. Country: ________________________________________________________________

Do You Hold Citizenship in Other Countries? Are any of the authorized individuals a Current or Former Senior
Political Figure Or Family Member Or Associate of a Senior
h Yes h No If yes, list countries: ________________________________________________________ Political Figure?
h Yes h No

Date Identifcation was Reviewed Picture Identifcation

h U.S. Driver’s license (State: _______ ) h U.S. Military Service ID
h U.S. State ID (State: _______ ) h U.S. Resident Alien/Immigration ID

____________________________________
h Passport (Country: _______________________ ) h Other ________________________
(mm/dd/yyyy)
Number on ID: ________________________ Expiration Date (mm/dd/yyyy): ______________

h Full-Time Employment. Must complete 1-6 below. h Retired. Must complete 5 below with former occupation.
h Part-Time Employment. Must complete 1-6 below. h Unemployed. Must complete 5 below with former occupation.
h Self-Employed. Must complete 1-6 below. h Homemaker. Skip 1-6 below.
h Military. Must complete 1-6 below. h Student. Skip 1-6 below.

1. Employer h U.S. Bank h U.S. Bancorp Investments, Inc. 2. Employer City and State

3. Years With Employer 4. Type of Business 5. Occupation 6. Work Phone (10 digits)

Investment and insurance products and services including annuities are available through U.S. Bancorp Investments, the marketing name for
U.S. Bancorp Investments, Inc., member FINRA and SIPC, an investment adviser and a brokerage subsidiary of U.S. Bancorp and affliate of U.S. Bank.
Insurance products are available through various affliated non-bank insurance agencies, which are U.S. Bancorp subsidiaries.
Products may not be available in all states. CA Insurance License# OE24641.
Investment and insurance products and services including annuities are: NOT A DEPOSIT • NOT FDIC INSURED •
MAY LOSE VALUE • NOT BANK GUARANTEED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY

Page 1 of 3 PERSONAL
30797 (10/22) v1.0
 [!llWealth Management CLIENT WORKSHEET
FOR A PERSON
U.S. Bancorp Investments

1 Client 1 (If custodial: Put minor’s information in this section.) (Continued from page 1.)
Annual Household Income What Is the Source of Your income?
Please include all types of income such as salary and hourly wages, overtime, bonuses, public List all sources of income. Examples: Business Ownership, Employment Income, Inheritance, etc.
assistance, disability, pension, interest, dividends, self employment, commission, rental pay, child
support, social security and retirement pay.

$
Total Asset Value (The value of your Anticipated Monthly Value of Cash (Currency) and Cash Equivalent Cashier’s Anticipated Monthly Value of Cross Border (Incoming & Outgoing
assets, including cash and investments Checks, Money Orders, Traveler’s Checks) Transaction Activity (in U.S. $) International Wires, ACH and Transfers) Activity (in U.S. $) Across All
held with U.S. Bancorp and held Across All Accounts With U.S. Bancorp. (If non-cash account, enter “N/A”.) Accounts With U.S. Bancorp. (If non-cash account, enter “N/A”.)
elsewhere.)
$ $
$
I I

Describe Your Source(s) of Wealth (How you obtained/grew your wealth, the nature of the assets, the countries where invested, any individual that has contributed to your wealth and how you plan to
continue to grow the wealth.)

2 Client 2 (If custodial: Put custodian’s information in this section.) (Continued on page 3.)
~----~~~~I -~
Legal Name (First, Middle, and Last) SSN/TIN Date of Birth

~---~~-~~l~I -~
Street Address of Residence (Cannot be a P.O. Box) City State ZIP

~---~~-~~l~I -~
Mailing Address if Different From Residential Address City State ZIP

Gender Marital Status Phone (10 digits) Alternative Phone (10 digits) Email Address Number of Dependents
h Male h Married (As on your tax return.)
h Female h Not Married

Citizenship/Residency Status. (For Non Resident Alien, complete the Non NAO Application.)
h U.S. citizen h Resident Alien/U.S. Permanent Resident. Country: ________________________________________________________________

Do You Hold Citizenship in Other Countries? Are any of the authorized individuals a Current or Former Senior
Political Figure Or Family Member Or Associate of a Senior
h Yes h No If yes, list countries: ________________________________________________________ Political Figure?
h Yes h No

Date Identifcation was Reviewed Picture Identifcation

h U.S. Driver’s license (State: _______ ) h U.S. Military Service ID
h U.S. State ID (State: _______ ) h U.S. Resident Alien/Immigration ID

____________________________________
h Passport (Country: _______________________ ) h Other ________________________
(mm/dd/yyyy)
Number on ID: ________________________ Expiration Date (mm/dd/yyyy): ______________

h Full-Time Employment. Must complete 1-6 below. h Retired. Must complete 5 below with former occupation.
h Part-Time Employment. Must complete 1-6 below. h Unemployed. Must complete 5 below with former occupation.
h Self-Employed. Must complete 1-6 below. h Homemaker. Skip 1-6 below.
h Military. Must complete 1-6 below. h Student. Skip 1-6 below.

1. Employer h U.S. Bank h U.S. Bancorp Investments, Inc. 2. Employer City and State

3. Years With Employer 4. Type of Business 5. Occupation 6. Work Phone (10 digits)

Page 2 of 3 PERSONAL
30797 (10/22) v1.0
 [!llWealth Management CLIENT WORKSHEET
FOR A PERSON
U.S. Bancorp Investments

2 Client 2 (If custodial: Put custodian’s information in this section.) (Continued from page 2.)
Annual Household Income What Is the Source of Your income?
Please include all types of income such as salary and hourly wages, overtime, bonuses, public List all sources of income. Examples: Business Ownership, Employment Income, Inheritance, etc.
assistance, disability, pension, interest, dividends, self employment, commission, rental pay, child
support, social security and retirement pay.

$
Total Asset Value (The value of your Anticipated Monthly Value of Cash (Currency) and Cash Equivalent Cashier’s Anticipated Monthly Value of Cross Border (Incoming & Outgoing
assets, including cash and investments Checks, Money Orders, Traveler’s Checks) Transaction Activity (in U.S. $) International Wires, ACH and Transfers) Activity (in U.S. $) Across All
held with U.S. Bancorp and held Across All Accounts With U.S. Bancorp. (If non-cash account, enter “N/A”.) Accounts With U.S. Bancorp. (If non-cash account, enter “N/A”.)
elsewhere.)
$ $
$
I I

Describe Your Source(s) of Wealth (How you obtained/grew your wealth, the nature of the assets, the countries where invested, any individual that has contributed to your wealth and how you plan to
continue to grow the wealth.)

3 Securities Industry Affliation (Client 1)

Is the Client or an immediate family member/domestic partner:
h Yes h No 1. A director, 10% shareholder or policy making offcer of any publicly traded company? If yes, symbol:__________
h Yes h No 2. Employed by Financial Industry Regulatory Authority, a broker/dealer, investment advisor or other securities frm? If employed by a
broker/dealer other than U.S. Bancorp Investments: U.S. Bancorp Investments must receive written authorization from your employer
authorizing the opening of an account with U.S. Bancorp Investments.
h Yes h No 3. A senior offcer of a bank, savings and loan, insurance company, registered investment advisory frm, registered investment company or
a person who could infuence the trading of investments in an institutional type account?

If yes to #1, 2 or 3:
Name of Person:________________________________________________________ Relationship of this person to the Client: ______________________________

Name of Firm/Employer: ________________________________________________ Address of Firm/Employer: __________________________________________

City, State and ZIP Code: __________________________________________

Securities Industry Affliation (Client 2)

Is the Client or an immediate family member/domestic partner:
h Yes h No 1. A director, 10% shareholder or policy making offcer of any publicly traded company? If yes, symbol:__________
h Yes h No 2. Employed by Financial Industry Regulatory Authority, a broker/dealer, investment advisor or other securities frm? If employed by a
broker/dealer other than U.S. Bancorp Investments: U.S. Bancorp Investments must receive written authorization from your employer
authorizing the opening of an account with U.S. Bancorp Investments.
h Yes h No 3. A senior offcer of a bank, savings and loan, insurance company, registered investment advisory frm, registered investment company or
a person who could infuence the trading of investments in an institutional type account?

If yes to #1, 2 or 3:
Name of Person:________________________________________________________ Relationship of this person to the Client: ______________________________

Name of Firm/Employer: ________________________________________________ Address of Firm/Employer: __________________________________________

City, State and ZIP Code: __________________________________________

Worksheet is used to capture information needed to open an account. U.S. Bancorp Investments Representative - Place worksheet in client fle.

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