Case File
efta-01368296DOJ Data Set 10OtherEFTA01368296
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01368296
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
BY SIGNING BELOW CUENT ACKNOWLEDGES THAT: (1) CUENT HAS RECEIVED, READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT, INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION: AND (2) THE INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS ACCURATE.
CLIENT ACKNOWLEDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPUTE ARBITRATION CLAUSE AT SECTION III, PAGE 5. AND CLIENT
AGREES TO
TERMS (ALI. ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL.
INITIAL HERE:
THE INTERNAL REVENUE SERVICE DOES NOT REOUIRE CUENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIRCATION
REQUIRED TO AVOID BACKUP WITHHOLDING. AND, IF APPLICABLE. THE CERTIFICATION REQUIRED TO ESTABLISH CLIENT'S STATUS AS A NON-U.S.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Information for ERISA employee benefit plan clients: U.S. Department of labor regulations require DBSI to disclose to a responsible plan fiduciary
certain information in connection with the services that DBSI provides to a plan, to assist the fiduciary in evaluating the reasonableness of ()BSI's services and
related compensation. The disclosure Is available online, at httplewswg.pwrn.db.conVamericasien/erisa_disciosure_pcs.html By signing below, you acknowledge
that you are a fiduciary responsible for the procurement of DBSI's services to the plan, you have read the disclosure and you understand the disclosure.
Individual or joint account (IF THIS IS A JOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable in any relevant jurisdictions that
may arise in connection with assets. Income or transactions in Client's account(s) and business relationship with DBSI.
CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CUENTS SPECIFY INSTEAD:
OTenants in cornmon:
Community
Signature
Print Name 7:arid-I
SSNiE IN
Signature
Date
Print Name
SSN/EIN
Date
?i3c!!
retains 50% interest in the community property upon death of the first spouse).
2
Signature
Date (-
a -
Print Name
SSWEIN
Corporation, partnership, twat or other entry:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions
that may arise in connection with assets. income or transactions in Client's account(s) and business relationship with OBSI. Furthermore. Client confirms that the
necessary information Ito the best of Client's knowledge and capabilities) is made available no less than annually to the relevant beneficial owneffsl, settlorts).
beneficiery(oes), partner-Is), etc. to enable such person(sl to fulfill any respective tax obligations that may ariso for such porsonls) in connection with Client's
business relationship with DBSI.
Name of Entity Southem Financial US
Employer ID No 66-0799192
Signature of Officer, Partner. Trustee. Authorized Party
Print Name /illsJeffrey Epstein
Data 7
Signature of Officer. Partner. Trustee. Authorized Party
Date
Print Name/Title
Signature of Officer, Partner, Trustee, Authorized Party
Date
Print Name/Title
13-AWM-0196
7
012145.0321113
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0059992
CONFIDENTIAL
SDNY GM_00206176
EFTA01368296
Technical Artifacts (7)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
SWIFT/BIC
ACCURATESWIFT/BIC
APPENDIXSWIFT/BIC
APPLICATIONSWIFT/BIC
ARBITRATIONSWIFT/BIC
CONTAINSSWIFT/BIC
INFORMATIONSWIFT/BIC
SIGNATORIESForum Discussions
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