Case File
efta-01450273DOJ Data Set 10OtherEFTA01450273
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01450273
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 CLIENT ACKNOWLEDGES THAT: (1) CLIENT HAS RECEIVED, READ MID 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 SF.CTION.III, PAGES, AND CUENT
AGREES TO ITS 7E MS (ALL ACCOUNT AGREE
AGREEMENT
AGREEMENTSIGNATORIES MUST INITIAL).
INITIAL
[
-
d
' 0--"
''.r-
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE CUENT'S CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP WITHHOLDING, AND. IF APPUCABLE, 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 pion clients: U.S. Department of Labor regulations require DBSI to disclose to a responsible plan fiduciary
certain information in connection with the eeMces that DBSI provides toe plan. to assist the fiduciary In evaluating the reasonableness of DBSI's services and
related compensation. The disclosure is available online, at lutpdAvww.pwm.db.comThmoricasrenterisa disclosure,pcs.Mmi. By signing below, you acknowledge
that you are a fiduciary responsible for the procurement of OBSI's services to the plan, you have read the disclosure and you understand the disclosure.
Individual or feint account IIF THIS IS A JOINT ACCOUNT. ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client aclatowledges 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 accounts) and business relationship with OBSI.
CHECK A BOX BELOW ONLY IF CUENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
0 Tenants In common: or
II Cornmunhy Property (for married couples In certain states: each spouse retains 50% interest in the community property upon death of the first spouse).
Signature
Date
Print Name
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Corporation, partnership, trust or other entry:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any lax oblwatecns and any other regulatory reporting duties applscablo to in any relevant jurisdictions
that may arise in connection with assets. income or transactions in Client's account(s) and business relationship with 0851. Furthermore, Client confirms that the
necessary information (to the best of Client's knov4edgo and capabilities) is made available no less than annually to the relevant beneficial owner(s), S0fttOdS),
beneficiary(les), partneds), etc. to enable such persorgs) to fulfill any respective tax obligations that may else to Stich person(s) in connection with Client's
business relationship with DBSI.
Name of Entity The Haze Trust
Employer ID No.
Signature of Officer. Partner, Trustee. Authorized Party
Date
413-7186414
irS in
Print Name/Title
Signature
Trustee, Authorized Party
A........
A. 4.40
i 1 ISI:)
of Officer. Partner,
....),^1
oat,
Print Name/Title
Signature of Officer, Partner, Trustee, Authorized Party
Date
Print Nameffitle
13-AWM-0198
7
012106.032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0 105825
SONY GM_00252009
EFTA01450273
Technical Artifacts (7)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Phone
413-7186414SWIFT/BIC
ACCURATESWIFT/BIC
APPENDIXSWIFT/BIC
APPLICATIONSWIFT/BIC
ARBITRATIONSWIFT/BIC
CONTAINSSWIFT/BIC
INFORMATIONForum Discussions
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