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 Summar
3A. Individual Details (for all parties)
Individual's Name:
Date of Birth:
Country of Residence:
Country of Citizenship:
Address of primary residence:
Has client resided outside of
his/her country of nationality (or
5 years or more>
yes # No
Profession/Occupation:
Tax ID / SSN:
Current Employer:
•
Position/Title/Rank:
Address of employer:
6100 Red Hook Quarter, 83 New York United States 00802
Does the person work as senior executive of a D6-recognized regulated entity in the financial
ndustry> or an entity kited on a 08-recognised exchange> (Not applicable for operating entities
'
Yes
No
I
Is the intlyidual a Politically Exposed Person (PEP)?(// Yet; dente)
Yes
I No
To the best of your knowledge, Is the individual related to an employee of the DB groupliFamie•
a Friendship, deso(e)
' Family
1.-- Friendship
1 None
To the best of your knowledge, is the individual party to a non-banking relationship wei Deutsche
Bank (e.g., external legal counsel, client referral source, supplier of goods or serrices)70/
Yesdesolbe)
u Yes
it No
If applicable, indicate which bank officers have met the person:
Indicate where and when the cNent meeting(s) took place:
Bank Officer Name(s)
Bank Office:
Client Private
pantile:
Client Place of
Business:
Other Location (specify):
Date:
CI
1.11
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 requiring source of wealth description as indicated in Secton 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:
•
. Business Owner
Salary/F-amings
. Investment
• Inheritance/Gifts
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 weakh>For business owners, how long in business, how many employees, level of profitability> Indicate type of business, countries of major
activities, important business partriers.)
Estimated Annual Income(S):
Estimated amount of investable assets(f):
Estimated Net Worth(1):
Other Known F. anal Institutions:
Amount of asses planned to invest wth PWM($):
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
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10.43
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066796
SDNY GM_00212980
EFTA01372893