WESTERN INTERNATIONAL SECURITIES, INC.

CLIENT DISCLOSURE FORM – LINKED CD’s

RR name: RR No.:

Customer name(s): Account No.:

Amount of investment: $

Name of product:

Purchase represents _______% of owner’s estimated liquid net worth.

Does client own other Structured Products? _____ YES ______NO

If yes, what percentage of clients Liquid Net Worth do all Structured Products represent? __________%

Receipt and Disclosure

I/We have received and read the offering material, including but not limited to, prospectus, strategy guide, term sheet or fact
sheet provided by the issuer. It is my/our responsibility to read all other offering materials, prior to investing in the product. I/We
have reviewed the risk factors described in the offering materials as they apply to my/our investment objectives.

RISK FACTORS

Principal Risk – In general, equity-linked CDs are insured by the FDIC up to the amount permitted by law. FDIC insurance
covers the principal of, and any guaranteed interest on, the equity-linked CDs. FDIC limits apply in specific circumstances.

Tax Risk – Equity-linked CDs may be treated differently than traditional CDs for tax purposes.

Call Risk – An equity-linked CD may be callable. If an equity-linked CD is called, the investor’s return may be less than the
yield for which the CD would have earned had it been held to maturity.

Market Risk – If the equity-linked CD is sold before maturity, it may be worth less than its purchase amount or face value.
The equity-linked CD will be subject to a number of variables, including stock market volatility and changes to the components
of the linked index. In addition, there is no guarantee of principal return unless the investment is held to maturity.

Liquidity Risk – Investors typically will have limited opportunities, if any to redeem their equity-linked CDs prior to maturity.
Moreover, the financial institutions do not guarantee the existence of a secondary market. Many equity-linked CDs do not
permit the early withdrawal of your investment without the consent of the financial institution. If you need to withdraw your
investment before the CD matures, you may incur withdrawal penalties.

By signing below, I or we, the client(s), have read and understand the features of this disclosure document and agree
with the information provided and disclosed. I/we understand the nature of the investment and all our questions
regarding this Investment have been answered. I/We believe this product meets my/our needs, considering the
investment objectives and risks associated with this Product.
Client Name(s): Date:

Client Signature(s):

Representative Signature: Date:

Principal Name

Principal Signature Date:

November2009