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Power of Attorney Affidavit and Indemnification ... - DWS Investments

Power of Attorney Affidavit and Indemnification ... - DWS Investments

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Deutsche Asset& Wealth Management<strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> <strong>Affidavit</strong> <strong>and</strong> <strong>Indemnification</strong> FormUse this form to validate a <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document dated more than 60 days <strong>of</strong> receipt byDeutsche Asset & Wealth Management.For assistance in completing this affidavit or making your request, please contact Shareholder Services.Call: (800) 728-3337 or e-mail: service@db.comYou must include a copy <strong>of</strong> the <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document, along with the appropriate Deutsche Asset &Wealth Management form or letter <strong>of</strong> instruction signed in capacity. Completion <strong>of</strong> this form will not allowyou to act via telephone for the account owner. You may use this form to act in capacity as <strong>Attorney</strong>-In-Factfor this transaction only.Step 1Account ownerNameSocial Security Number on AccountAddress <strong>of</strong> Record City State Zip( )Daytime Phone Number Extension Account NumberStep 2<strong>Attorney</strong>-in-fact information( )Name <strong>of</strong> Attourney-In-Fact Daytime Phone Number ExtensionMailing Address City State ZipBy checking this box, the <strong>Attorney</strong>-In-Fact will receive copies <strong>of</strong> account statements <strong>and</strong> confirmation statements by mail.Step 3<strong>Attorney</strong>-in-fact affidavit <strong>and</strong> indemnificationI, the undersigned <strong>Attorney</strong>-In-Fact, , being duly sworn, deposes <strong>and</strong> states under penalty <strong>of</strong>perjury that:I am the <strong>Attorney</strong>-In-Fact named in the attached <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> executed onDate – MM/DD/YYYYby (“Account Owner”); <strong>and</strong>The Account Owner is living <strong>and</strong> has not revoked, terminated or suspended the <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong>; <strong>and</strong>The Account Owner was competent on the date <strong>of</strong> execution <strong>of</strong> this <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong>; <strong>and</strong>A petition to determine the incapacity <strong>of</strong> or to appoint a guardian for the Account Owner is not pending in a court <strong>of</strong> law; <strong>and</strong>continued on next pageNo bank guarantee | Not FDIC insured | May lose value Page 1 <strong>of</strong> 3


Step 3<strong>Attorney</strong>-in-fact affidavit <strong>and</strong> indemnification (continued)In the event that more than one <strong>Attorney</strong>-In-Fact is named in the attached <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document, I represent that I amauthorized to act, severally or individually, <strong>and</strong> that Deutsche Asset & Wealth Management may follow any <strong>of</strong> my instructionsindependent <strong>of</strong> all other attorneys-in-fact; <strong>and</strong>I underst<strong>and</strong> that in the event <strong>of</strong> conflicting instructions given by <strong>Attorney</strong>s-In-Fact or an Account Owner <strong>and</strong> an <strong>Attorney</strong>-In-Fact, Deutsche Asset & Wealth Management may restrict the account until joint written instructions are received that aredeemed sufficient; <strong>and</strong>I hereby agree not to exercise any powers granted to me by the attached <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document if I know or have reasonto know that the <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> has been partially or completely revoked, terminated or suspended or is no longer valid dueto any reason whatsoever including death <strong>of</strong> the Account Owner; <strong>and</strong>I hereby agree to fully indemnify <strong>and</strong> hold harmless <strong>DWS</strong> <strong>Investments</strong> Service Company, <strong>DWS</strong> <strong>Investments</strong> Distributors, Inc.,<strong>DWS</strong> Trust Company, each <strong>of</strong> the <strong>DWS</strong> Funds, the registered investment companies advised by Deutsche InvestmentManagement Americas, Inc., <strong>and</strong> their affiliates, control persons, <strong>of</strong>ficers, directors, successors, assigns, employees <strong>and</strong>agents from <strong>and</strong> against any <strong>and</strong> all losses, liabilities, claims, <strong>and</strong> costs (including reasonable attorneys’ fees) directly orindirectly resulting from transactions made in accordance with my instructions.The attached <strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document will remain in full force <strong>and</strong> effect until such time as appropriate written notification<strong>of</strong> termination, revocation or significant alteration is received by <strong>DWS</strong> <strong>Investments</strong> Service Company at the below address.I also agree that any information given on this <strong>Affidavit</strong> <strong>and</strong> <strong>Indemnification</strong> is subject to verification.This <strong>Affidavit</strong> is made regarding <strong>DWS</strong> Fund account number, ______________________________ to induce acceptance <strong>and</strong>recognition by Deutsche Asset & Wealth Management <strong>of</strong> the authority granted the <strong>Attorney</strong>-In-Fact by the terms <strong>of</strong> attached<strong>Power</strong> <strong>of</strong> <strong>Attorney</strong> document.By signing this form, I certify that all account information <strong>and</strong> disclosures made on this form are true <strong>and</strong> accurate.Affix Medallion Signature Guarantee or Guarantee stampPrint NameSignature <strong>of</strong> <strong>Attorney</strong>-In-Fact(You must sign in capacity†.)Date – MM/DD/YYYYSpecial note to Medallion Signature Guarantee guarantors: By affixing the Medallion Signature Guarantee, youare verifying the identity <strong>of</strong> the individuals <strong>and</strong> entities assigned to this account <strong>and</strong> are accepting liability for anymisrepresentation as it applies to this registration <strong>and</strong> any accompanying documentation.Medallion Signature GuaranteeA Medallion Signature Guarantee is issued by a bank, savings <strong>and</strong> loan, trust company, credit union, broker/dealer, or anymember or participant <strong>of</strong> an approved signature guarantee program. Please note that a notary public is not an acceptableguarantor. An <strong>of</strong>ficer <strong>of</strong> the institution will ask for identification to be sure that you are, in fact, the person identified on thisform <strong>and</strong> the person signing it. Once the guarantor has reviewed your request, verified your identity <strong>and</strong> your authority toact on the account presented to them, they will affix a Medallion Signature Guarantee stamp to your form.Deutsche Asset & Wealth Management prefers Medallion Signature Guarantee stamps. We must receive an original stamp.If more than one signature is required on this form, we will need separate stamps for each signature. If you are obtaining anon-Medallion Signature Guarantee, please contact us. We may require additional documentation to complete your request.†You must sign in the capacity <strong>of</strong> your title as it relates to this account, i.e., Joe Smith, <strong>Attorney</strong>-in-fact. The institution providing the Medallion SignatureGuarantee will require additional documentation for this type <strong>of</strong> signature. You may wish to contact the institution to confirm the documentation they requireto provide you with a Medallion Signature Guarantee.Page 2 <strong>of</strong> 3


Please mail completed form to:<strong>DWS</strong> <strong>Investments</strong> Service CompanyP.O. Box 219557Kansas City, MO 64121-9557Overnight Address:<strong>DWS</strong> <strong>Investments</strong> Service Company210 W. 10th StreetKansas City, MO 64105-1614Deutsche Asset & Wealth Management represents the asset management <strong>and</strong> wealth management activities conductedby Deutsche Bank AG or any <strong>of</strong> its subsidiaries. Clients will be provided Deutsche Asset & Wealth Management productsor services by one or more legal entities that will be identified to clients pursuant to the contracts, agreements, <strong>of</strong>feringmaterials or other documentation relevant to such products or services.<strong>DWS</strong> <strong>Investments</strong> Distributors, Inc.222 South Riverside PlazaChicago, IL 60606-5808www.dws-investments.com© 2013 Deutsche Asset & Wealth Management. All rights reserved. (03/13) B-11227-4 POA-AFF

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