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efta-01392773DOJ Data Set 10Other

EFTA01392773

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DOJ Data Set 10
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efta-01392773
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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 Services, you understand that you will be required to enter into a separate Internet Banking Services Agreement with DBTCA before you can access 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 fulfil! 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 account(s) and your business relationship with DBTCA Furthermore, you confirm that the necessary information Ito the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner's). senior's), beneficiary(ies), partner(s), etc. to enable him/her/ them to fulfill any respective tax obligations that may arise for him/her/ 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 thorn 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 accurate. The Terms and Conditions for Deposit Accounts are subie to.change. Acceptance You understand that this apoticaji nt boiders Signature Joint Account Holder's Signature Date bare P.MY.2rni rWein sa„, . rietZlIFM38.. .9 a .s..H 1;44.W . jer.e v*-.7., elK ,S.. * 4 .t: ..;,ertssele,;- -the ...tteVetl 1/2.4i,..4ta 114 4,,,,tag Nente•rt- SXI:24;'"Lnepn+latt‘Fribr}lirift%Minfft7*W.MMPWIt.r.YigrtettLY.,.rearitiXt .4.O;t4rV.1*(;47reatatNVAttreg.Eay.'.'W.t.-ktr?;Min'*AE-INSIYArta oTiveat Jo 74._ 7' -‘otcli ‘,1j72.iti-itX1sIttle bVimti?"Ci. c4tinl-t. . ent er7 , err—e-rial dr IZZ%153fittst.c_it '., ,.• ,Lra-rieKtn?...0-5, S., XVI ' 1..n. 4.itPI"4t4 .'In;I' :4V: 3-I. ArtMlirne :Ve-r/E'alreett e,0411M:er Mai 40,4 ,ii-iVrtlr,...4.; • • . .diCiteg. 1141ta: S . *VOW a. to a via"' aienVnZti ti7VAt 4t9iscs,rEn. atiz4.-PWAIIMISVM, Set•Zi. rk• ;get b•x•••• T:vg. ✓:VA..), rf,s `V.tt.%?:CW:AWC2'W.:itir45 4g•krrigeiCtiNg"illicraOr • 7.....*‘,..v4ix,a•Sg4;31,,.....,. nit/ Water. 46/1O aielkt 717p.rfsc• Lcrao hr251111 rtq'SOMinj acn cl,f;2;)1(*t-4049ii, fr tsy "c-AcaliCline'' =.1..tierat fl ys( tszaataz-areltarr zhentt:AttIva• bt...zcsah 3 13-AMA-Ole' 013959 032613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0098041 SDNY_GM_00244225 EFTA01392773

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