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efta-01450273DOJ Data Set 10Other

EFTA01450273

Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01450273
Pages
1
Persons
0
Integrity

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Extracted Text (OCR)

EFTA Disclosure
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)

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Email addresses, URLs, phone numbers, and other technical indicators extracted from this document.

Phone413-7186414
SWIFT/BICACCURATE
SWIFT/BICAPPENDIX
SWIFT/BICAPPLICATION
SWIFT/BICARBITRATION
SWIFT/BICCONTAINS
SWIFT/BICINFORMATION

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