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efta-01392765DOJ Data Set 10Other

EFTA01392765

Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01392765
Pages
1
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service If you have Selected to receive Internet Banking Setvices, you understand that you will be required to enter into a separate Internet Banking Services Agreement with DBTCA before you can aocess the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below, you acknowledge receipt of DBTCA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to you in any relevant jurisdictions that may arise in connection with assets. income or transactions in your accounts) and your business relationship with DBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your accounts) and your business relationship with DBTCA. Furthermore. you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s). settlodsl. beneliciary(ies), partner(s). etc. to enable hirn/herf them to fulfill any respective tax obligations that may arise for him/herr them in connection with your business relationship with DBTCA. Please complete and attach separate W-8 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to this Application and agree to be bound by them. In addition, you agree to notify us immediately of any material change to the information provided by you on this Application. You represent and warrant that all of the information provided by you on this Application is at ciliate. t The Terms and Condi ion for Deposit Accounts are su t change. Accept nee you ndersteed that this et0Unt Holder's Signature Joint Account Holders Signature For;Befiki eti:tanIttlittyievAld'bnc. perit7favvirfara. 2t r sulitt 1 4.tfct. ( ctgifAtt `OA rkArt-;,:t k"..• 2 ! 03 at' 477 a V•••4 lat•Mt.: lit • I•L'!'ll yfintInekt eterev, 149 porn , rtt. 31;:ta Aix L , L.9.11;t-enaA,,rat".9. -zitv•;-:77,ttiri≥wrcer“-.-ely;.% Date Date 44`.“, t:•• ecalt*"1411, 41fr el tir:€.1.e`riWPriantXritre4ferlerk < C3 /4 4WC :C a 7MAL rved.,ef, g.o.litgAgsf.zie %bit s %;:t 0, igfit' °1& ?‘"75iliki "Sir trf ilk 4, 7 40, *AO 40 cyl-refirz yfri!Thea; r a f. A- A vt‘ :;41`• ••""ite"--4';'1441:Ciattieji:ii:Firitlicflyecipcies;cat4taci.kt-,-54ambymwt",„- .ffriiittAi9"."'''''44.-7.*Watp-47#1-44Pritatr:Ve';%443$ IttMelnit ) " xs5W.4.1;:n . 'Eat 3 • 944:4O: CAcce fed. ISit t-e .! ii;fr; Art' ? pe.WVA?#...t"4.194 e4ainettcs:WolfeW,4, 7 41.-S:Xtritc .:5t 1-k r 04.7ten7 glYX !gf.0%,, RierNIT•'* 10P0,7%I.XtWarfrItir*% •9:•AN Trite` lan 0ea O5 atlit 'As.. 4 sie DB Pi4, SyySeltW-a• ra6Vskpi.....p.:;74:43.!,;;-4,T,..r .nalir 04: tgs:4:74 etLREact V.(44.M fm-gr.vac", 'fr• 13AWM4101 013959.032613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0098033 SDNY_GM_00244217 EFTA01392765

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