Text extracted via OCR from the original document. May contain errors from the scanning process.
7/15/2019
KYC Print
One sheet must be established for EACH INDIVIDUAL PARTY In Section 2. Account Ownership Sum
3A Individual Details (for all parties)
Individual's Name:
Harry Beller • 00000487202
Date of Birth:
5/9/1956
Country of Residence:
USA
Country of Citizenship:
USA
Address of primary residence:
12 Gobi: Drive Monsey NY 10952 United States
Has client resided outside of
his/her country of nationality
for 5 years or more?
Li Yes Ii No
Profession/Occupation:
Accountant
Tax ID / SSN:
081-52-0727
Current Employer:
HBRK Associates, Inc
Positionflitle/Rank:
Address of employer:
575 Lexington Avenue, 4th Floor Monsey NY United States 10022
Does the person work as senior executive of a DB-recognized regulated entity in the financial
Industry? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities
n
X
Yes s!
'
j No
Is the individual a Politically Exposed Person (PEP)?(I/Ye desatbe)
....
.,.
U Yes
kl No
To the best of your knowledge, is the individual related to an employee of the DB group?(f
Forney or FriendsNp, descnbe)
l : Family
Headship
9-. None
To the best of your knowledge, is the individual party to a non-banking relationship with
Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or
services)?(/Yes,descrte)
1.
:11
Yes
No
If applicable, indicate which bank officers have met the person: Indicate where and when the client meeting (s) took place:
Bank Officer Name(s)
Bank Offi
Oidiets Private
Domicile:
Client Place of
ce:
Business:
Other Location (specify):
Date:
l
I...1
1.11
—
1.3
1- Wealth Details for this individual are not filled in, because they are the same as for the following person:
38. Wealth Details (Only for parties requinng source of wealth description as indicated in Section 2)
Nature of the Individual's Business:
Primary Country of source of wealth/source of Funds?
Primary industry of source of Wealth/Source of Funds?
Summarize Source of Wealth:
r t Business Owner
Salary/Eamings
Investment
Inheritance/Gifts = I Other:
Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did settlor accumulate wealth? For inheritance, how
did family accumulate wealth?For business owners, how long in business, how many employees, level of prchtability? Indicate type of business, countries of major
activities, important business partners.)
Estimated Annual Income(S):
Estimated amount of investable assets($):
Estimated Net Worth($):
Amount of assets planned to invest with PWM($):
Other Known Financial Institutions:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
https:ridbforcepb.my.salesforce.comiserylet/servlet. Integration?lid=01N30000000D9Di&eid=50032000015VRiO&P=18linkToken=VmpFPSKNakF4T1...
6115
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066777
SDNY_GM_00212961
EFTA01372875