EFTA Document EFTA01447991

Contact Details Telephone Number (Home): Telephone Number (Work): Telephone Number (Cell): Other Telephone Number Fax Number (Home)._ Fax Number (Work): Email Address (1): Email Address (2): CIP Details ID Type: 0 Men Registration Card 0 Driver's License 0 Other Government ID 0 Passport ID Number Date of Issue: Date of Expiration: Country of Issue: Financial Details Annual Income: O Less than $50,000 O 50,000-99,999 O 100.000-249,999 O 250.000-499.999 O 500,000-999,999 O 1,000,000-2.499,999 O 2600.000-4.999,999 O 5,000,000 and over Federal Tax Status: CI 0-15% CI 15,1-32% CI 32.1.60% CI 50.1% or more Approximate % of net worth that is investable assets (stocks, bonds, etc.)? Source of Wealth: 0 Inheritance or Gifts CI Corporate Executive O Sale of Other Assets O Professional Earnings O Sale of Securities O Public or Gov't Official O Lottery or Gaming O Sale of Business Net Worth (Excluding Principal Residence): O Less than 650,000 CI 50.000-99,999 O 100,000-249,999 K 250,000.499,999 O 500.000-999.999 O 1,000,000-2,499,999 O 2,500.0004999.999 O 5,000,000 and over What % of net worth is Retirement Accounts? O Individual Earnings K Sale of Real Estate O Corporate Earnings O Business Owner 0 Other (please provide): Liquidity Needs: 0 Low (Somewhat important) 0 Medium (Important) 0 High (Very important) Time Horizon (approximate year account owner expects to achieve the financial goals for this account): OR 0 10 years or longer Year Investment Experience Investment Type Experience Annual Activity Level (Select one) (Required) Years of Investing None j Limited No history (1-5 transactions of any per year) transactions I Moderate (6-15 transactions per year) High (Over 15 transactions per year) Equities Options Fixed Income Mutual Funds I Exchange Traded Funds (ETFs) Real Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency Hum. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL 12.FINM.0357 010434.062212 DB-SDNY-0102799 SDNY_GM_00248983 EFTA01447991