EFTA Document EFTA01387990

One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details 'a ' a. cc': esi ndividualt Name: Date of Birth: Country of Residence Russan Federation Country of Citizenship: Russian Federation Address of primary residence- Begovaya Street 24 Apt 3 Moscow NA Russ an ceceration Has client resided outside of his/her country of nationality for 5 years or more? CI Yes R No Profession, °coupe; ion N A Tax ID: SSN 722993433 Cur