EFTA Document EFTA01392689

ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service II you have selected to receive Internet Banking Services, you understand that you will be required to enter into a separate Internet Banking Services Agreement with 0BTCA before you can access the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below, you acknowledge receipt of DBICA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to you in any relevant jurisdictions that may arise in Connection with assets, income or transactions in your accounts) and your business relationship with OBICA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may anse in connection with assets, income or transactions in your account(s) and your business relationship with DBTCA. furthermore, you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial ownerIsl, settlor(s), beneficiary(ies), partner(s), etc. to enable him/herr them to fulfill any respective tax obligations that may arise for him/her/ them in connection with your business relationship with DBTCA. Please complete and attach separate W-8 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions tor Deposit Accounts attached to this Application and agree to be bound by them. In addition, you agree to notify us immediately of any material change to the information provided by you on this Application. You represent and warms% that all of the information a/twined by you on this Application is accurate. The Terms and Conditions for Deposit Acco • are subject to change. Acceptapce You garotted that this zuri A ru Holder's Signature Joint Account Holders Signature taintrzt,' lia2-- --: ittet vat i, 9tain--___ 11;•.-Sthta- Ps It% :r. - .;, . ., --ipv4-4.--..-n-.e va-4,15.1/2'444-ci !Nara ct orsiinvirarger; fkr.*Ist- - - x.veirr, - ik. e JV t.'. :CA: w.c.ft lir :V ' S iCg 4):a '0. A ttetri ..941 ,4 1 0 4 AV I t iel e A el. v6 i~ tamer _3s Atiat.M1,141renVcdnalts;44e- -lir "r. hdfizve-4,10,,r-WklarinitY5a• `L-5h; mega I% avd- te 7/ 11/ 3 Date Date -Tr 'Jac t.."1.7 • 10.9174141, gcit it er 60' 1)k Ct? vgockriaapoimswittsi •60W41 ti:Nameir ttS716 MP& gX.C. 4 .iairinigekettf T-"C .,00•04,0C v ' 3C..4 in• l'ilf. W .4. c ° '5-.4.• •4 -v 47 /7? e 14' l... 3:..i,,,.. ".. C4 ;••!1:".1,-.", ,....6, 00.., •wis.-. ntic ...J: n in 76..texad 4 .>0(17.1.11. . Ana-ii,..irrni.en iet.tea4s.Bartaii i.an.7"..S bgkergiC54 VAtitaSir-r:-V4. 0e ,r., It 40C it a x.• S -. Lt. 3 Srt 1 4 ; C.4 F Yin as 13-AWM4101 013969.037613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0097951 PROT1 PROT0