EFTA Document EFTA01387982

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 United States Country of afar sh o Address of primar y residence- 301 E 86th St. Apt 8H New York NY 10085 United States Has client resdeo out sloe of hig/her country of nationality for 5 years or more? 0 Yes lg. No Professor : Occupat ion. Interior Decorator Tax ID: SSN 105-98-1619 Current Em