The Depository Trust Company

Correspondent Authorization and Acknowledgement

The undersigned, a Participant (Participant) in The Depository Trust Company (DTC) hereby
authorizes the undersigned Correspondent (the Correspondent) to have access to the account of
the Participant specified below: _____________________________________________
DTC Participant Number: ________
Correspondent Name: ___________________________
Identify the Super Access Coordinators at Correspondent being registered.
Names:

Specimen Signatures:

_____________________

_____________________

____________________

_____________________

In order to induce DTC to make certain DTC facilities available to the above named
Correspondent, Participant hereby acknowledges and agrees that:
1. Participant and Correspondent shall comply with the Rules and By Laws of DTC and
Participant, on behalf of itself and its Correspondent herein designated, shall be bound by
all of the provisions thereof including, but not limited to, DTC Rule 2, Section 2 which
states, in relevant part, that A Participant which utilizes the services of the Corporation
for a Person which is not a Participant shall, so far as the rights of the Corporation, other
Participants and Pledgees are concerned, be liable as principal.
2. DTC shall have all of the rights and remedies provided in and contemplated by the Rules
and By Laws of DTC.
3. This authorization of the Correspondent shall remain in full force and effect until
terminated by Participant upon written notice to DTC in accordance with DTCs
Procedures.
AGREED:

______________________________________
Participant Name
_______________________________________
Participant Number

BY:

________________________________________

Print Name/Title:

_________________________________________

Date:

___________________________________________

Acknowledged and agreed this ______ day of _____

Correspondent Name
By:______________________________
Name: ___________________________
Title:_____________________________

Please email this document to: webrsg@dtcc.com

or Fax a copy to 813-470-1521