EFTA Document EFTA01345198
KYC Print Page 5 of 19 One sheet must be established for EACH INDIVIDUAL PARTY in Secdon 2. Account Ownership Summary 30. Individual Details (for all parties) Individual's Name: Darren I ndyke - 00000486405 Date of Birth. 2 19 1965 Country of Residence USA Country of Citizenship. USA Address of primary residence- 2 Kean Court Livingston NJ 07039 United Slates Has client resided outside of his/her country of nationality for 5 years or more? O Yes V. Na Professor+, Occupation.
Summary
KYC Print Page 5 of 19 One sheet must be established for EACH INDIVIDUAL PARTY in Secdon 2. Account Ownership Summary 30. Individual Details (for all parties) Individual's Name: Darren I ndyke - 00000486405 Date of Birth. 2 19 1965 Country of Residence USA Country of Citizenship. USA Address of primary residence- 2 Kean Court Livingston NJ 07039 United Slates Has client resided outside of his/her country of nationality for 5 years or more? O Yes V. Na Professor+, Occupation.
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Account Type: Account Number: n. • Anwitamai Chula A (OICID.Re4 Hook QU.11/(+eri34 arTh0rrICIS Sign. la Req. Te oo Date: 2 Name: Southern Trust Company, Inc. EIN: Nal=rejnan / A6c-c-te--00-- SSN: ID No. Name: SSN: ID Type: No: . . SSN: ID Type: o: vw• bereby ack.o•rledp brat mend tbc Depasit &awn Aroma tho PS Bacon lekcsable Skim. aid piney Policy. ad die proact rain tad kn. Prepared by Authorized CLOSED ACCOUNT 10)8bi CONFIDENTIAL SDNY_GM_00013623 L CONFI
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