BROKERAGE ACCOUNT APPLICATION FORM

Account Information

Account Registration

Select the type of registration you want on your Account

Account Holder

Mr Mrs Ms Dr

Securities industry regulations require that we request the following information:

Employed Self-Employed Retired Unemployed

Marital Status

Single Married Divorced

Additional Account Holder (If applicable)

Mr Mrs Ms Dr

Securities industry regulations require that we request the following information:

Employed Self-Employed Retired Unemployed

Marital Status

Single Married Divorced

Is any member of your household a control person (Example: A person who can exercise power or has a controlling interest in a company) in a publicly traded corporation?

Yes No

Investment Profile

Account Holder

Investment Knowledge

None Good Limited Extensive

Investment Experience

None
Limited
Good
Excellent

Common Shares

None Limited Good Excellent

Preferred Shares

None Limited Good Excellent

Bonds

None Limited Good Excellent

Money Marke

None Limited Good Excellent

New Issues

None Limited Good Excellent

Mutual Funds

None Limited Good Excellent

Options

None Limited Good Excellent

Commodities/Futures

None Limited Good Excellent

Venture Situations

None Limited Good Excellent

Trading Experience (years):

Additional Account Holder

Investment Knowledge

None Good Limited Extensive

Investment Experience

None
Limited
Good
Excellent

Common Shares

None Limited Good Excellent

Preferred Shares

None Limited Good Excellent

Bonds

None Limited Good Excellent

Money Marke

None Limited Good Excellent

New Issues

None Limited Good Excellent

Mutual Funds

None Limited Good Excellent

Options

None Limited Good Excellent

Commodities/Futures

None Limited Good Excellent

Venture Situations

None Limited Good Excellent

Trading Experience (years):

Investment Goal

Capital Preservation Income Growth Speculation

Investment Objective Definitions: Capital preservation: The objective of capital preservation is to protect your initial investment by choosing investments that minimize the potential of any loss of principal. The long-term risk of capital preservation is that the returns may not be adequate to offset inflation. Income: The primary objective of an income strategy is to provide current income rather than long-term growth of principal. Growth: The objective of a growth strategy is to increase the value of your investment over time with recognizing a high likelihood of volatility. Speculation: A speculator's objective is to assume a higher risk of loss in anticipation of potentially higher than average gain by taking advantage of expected price changes

Does anyone other than the account holder(s) have trading authorization over the account?

Yes No

If yes, please complete and mail Power of Attorney form to add an individual as having trading authority

I /We am/are of legal age to enter in this agreement. I hereby request that Clearwater Management open an account in the name(s) listed as account holder(s) on this application. I/We the undersigned agree to provide instructions as an authorized signatory to Clearwater Management via phone, fax, email or any other method deemed appropriate by Clearwater Management without instructions being duly confirmed in writing. Therefore, this signed document allows Clearwater Management to process transactions sent via any of the above mentioned mediums without liability in any form to Clearwater Management or its employees.

I understand there are fees associated with establishing, maintaining, engaging in transactions, and transferring assets out of this account. I further acknowledge that securities products purchased or sold in a transaction with Clearwater Management are subject to investment risks, including possible loss of the principal invested. I understand that Clearwater Management does not provide tax, legal or accounting advise.

Signature of Primary Account Owner

Signature of Co-Account Owner