EFTA Document EFTA01362381

KYC Print Page 7 of 19 One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details ;for all parties) Individual's Name: Harry Belkw - 00000467202 Date of Birth. 5 9 1956 Country of Residence! USA Country of Citizenship. USA Address of primary residence- 12 Golan Drive Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or more? Oyes 2/. No Professon, Occupation: Accoun