Advisory Position of Trust Certification

Account Name*

Account Number*

Length of time you have known this client*

Role of Advisor*

Beneficiary

Power of Attorney

Executor

Trustee

Other

Other*

Are you receiving fees?*

Length of time you have been in this role*

Reason the client appointed you for this role*

Does the customer have any impairment that renders the customer unable to protect his or her own interests?*

Does the client have more than one account with you or the firm?*

Yes

If so, do you serve in a similar role on those accounts as well?*

Please describe how you will manage this account*

Representative Signature*

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Brighton Securities Corp Signature

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Account Restrictions (Compliance/Back Office Only):

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