EFTA Document EFTA01370535

Deutsche Bank Wealth Management Structured Products Agreement and Approval Form Please Complete All Sections recount Number Aceciint Nan? Account Type Inca%'dual Joint Trost Partner ship Limititx: Liability Corr pony Corporation Other (specify): NOTE: IRA and ER ISA accounts are prohibited from purchasing Structured Products. Account and Owner Information: Provide requested information tor each beneficial account owner ("Client"). If more than one owner exists, the Structured Products Agreement and Approval Supplementary Form to this Agreement may be required. Entitle Name.. or Nit. Mkhilet last Name of Indlvemal or Trustee or beoutor Address COUllUy MA'AM SUNS Business Address Tyve of Eta:wits, Blubdate IttlIrDOgYVYY Phone Number of Dependents Employer Portion Narnefs) of porsortM other than account owner(S) authorized to place orders for the 0000tint Client(s) Financial Information Approximate Aggregate Annual Income of Account Owner(s) from All Sources Less than $50.000 550,000 - $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 51,000.000 - $2,499,999 $2,500,000 - $4,999,999 $5,000,000 and over Sources of Income (Approximate) Salary/Bonus Interest/Dividends Other (specify): Business Phone Approximate Net Worth € Less than $50,000 $50,000 - 599,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 - $4.999,999 $5,000,000 and over Years Held Approximate Liquid Net Worth Excluding Principal Residence Less than $50,000 $50,000 $99,999 $100,000 — $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 - $4,999,999 $5,000,000 and over mg; Pnoe 1 of? MM. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0063430 CONFIDENTIAL SDNY_GM_00209614 EFTA01370535