Case File
efta-01282885DOJ Data Set 10OtherEFTA01282885
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01282885
Pages
4
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
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$l: Wealth MaYiStn:en i!
BTCA DOY10eit AcOo.uht 0006614
Private Wealth Premium/11
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TargetAmount
Trigger Amount
Private Wealth Pririlluiti'M
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Consumer Detiit .Cardli'
la Joint Appiidant DOB Cord
.8irsinaselDebit Card
.
▪
DeluxeCheckbook Style*
O Name Only
O
Name and Address.
Doplielite Statement
Addt.
' Zip Code.
.0 Mailing address Ilf different):
Name
dierif.titelationship.
K individ.tril AeOcsitt,
•
Joint Tenants with RigM-
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Landlord Master Escrow
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O Unified Liebtfity:ParintirShip.
CONFIDENTIAL
SDNY_GM_00038480
CONFIDENTIAL - PURSUANT TO FED R. CRIM. P. 6(e)
DB-SDNY-0001304
EF1'A_00149089
EFTA01282885
SONNIIT;tiNSICONIParkiele
Name of Account Title
Joint APSeci
pea neme, first name ntidellieiNtiagor ilfogeris
Mister* drat name: rrediarlinirlail
Siam& Security member or:Taxpayer:O Number-
SocheSecumy Number or Tainsayar.ID Nome's.
t
ii
City Stetaind Zip Code "
alft.iiili0444011
city, s tetew
.
Number
••••••7."-Ttrr? ,
Sacco 19.4,
Kb" tail
Dare
Binh
•
Marne of:Employer
Namalet Erreployet
Address
.
•
•
•
Address
.000 cygt -teritir idep- toidoilip polio
Impertant information
to help the government fright the funding otteriorigrn and Money iiimdering activities, Fedeial law requires adfinancial
Institutions to obtain;verife.end record Information that identifies each.person who establishes anacitount, inyestMent.or
other business relationship with a fnantial instituntio thisMeans Thai we will ask for yOur name; addrege and other
information that will allovi us to identifyWu. We maielso ask to misidentifying documents Such as:a certificate of
formation or, geed Standing/00gal entities) ors pitesderver other,Ohoto identification (indiVidueb).
•
:3rd 8U Notice
.G6vernmental Yules.hatro also broadened the Scope of the flank's obligations to aid in the fight against mbriey laundering
and terrorist lancing these
call for an -active InvolvementOf both assetmanagemont firms and Mei:Clients. For
newand-existing clients we currently have a legal obligation to ask our.cusiorrians questiong regarding their identities.
addresses, source of Witt and; if nectissoryriegalsepresentatives. authorized signatories, beneficial owners or control
involutes and to collect requisite documentation to substantiate the iriformition. Also, enhanced anti-money thundering
recWirer,nentarequire that 'should any Of 'the'abigye personal or institutional Information change, our taints would be
'obliged tairnmedietely notify pa of thechagge(s) and proeideus with relevant documentation to verify these changes.
.
.
•
Telephone, Fatsithile.or Ernail ItiStfliCtIOEIS
By signing below, you agreethat from Omelet time, ournali give instructions by mdephone..facsimiteer email regarding
the aboVe captioned acibundM (defined.he rein as -Verbal Instructions") It is understood,
the 'risk of Verbal
Instructions being given by person or persons purported to be youis your own. Absent the gross negligence or-willful
misconduct of Deutsche Bank trust Company Americas (DBTCA). you 'area toindemnifrand hold harmless DBTCA for
any diaiwis,lossea expenses. costs or attorneys' feet-resulting frbm MICA'S acting npon such misunderstood arid
unatithorized Verbal Instructions. You understand Chit 08tCA may, but shall not be required to. soskVerilieetken of your
,verbal; facsimile of email instructions by call.bag,k. In 'cave of doubt, DBTCA may in its sole discretion refese foexectite
your Verbal Instructions of anygort thereof, without ineurring anyfisbiliry. DBTCA is under no objigation to execute your •
:Verbal IngtnititiOnS&O tsanafer fonos or securities, tia.any.gccoonne) witheitt written instructions blaring your Ortginal
signature,
.JOint Accdtint Disclosure.
You have opened Nriplaorxigrrewith DBTCA and acknowledge receipt of the following. informatioM itOs, deposit and any
additions to the account shaffbecomeghe property of each owner as joint tenants, and DBTCA may relapse-the entire
account to any owner during the lifetime' 1 eltoveners; DBTCA may honor Cheglitt..prders or withdrawal tegrestsffrorn
any owner during the lifetime of all owners. The Bank maybe required by service qi legal preens to remit funds held in
the joint account to satisfy a lodgment entered against, or other valid debt Incurred by, e ny owner of the account. DBTCA
may hoior checks: ordereor withdrawal imotristafrern the survivor(i) after the death of any oivnerfsland mey iron the
account as the sole proper*. of .the'sOrvivor(e) after the death-of anYWiner(s).., Unfits DBTCA receives written notice
signed by any owner. not-to ply or deliver any joint deposit or addition or sacnial,.08TCA shall not be liable to any owner
forContinuing to honor checitscoiders or withdrawal requests from any owner. Altet-the receipt of the notice' referred to'
in the previous sentence, DBTCA may require the written authortiation ol any or all joint Mime/Sao any further payments
or deliveries.
2
13-MA940101
OtegsgoriM3
CONFIDENTIAL
SDNY_GM_00038481
CONFIDENTIAL — PURSUANT TO FED R CRIM. P. 6(e)
DB-SDNY-0001305
EFTA_00149090
EFTA01282886
ATM/Debit ServiCe
YOu agree Thal the retention or use. of the ATM/Debit card constitutes acceptance of the terms and conditions of the'
CardhOlder Agreement contained in Itia Towns end Conditions of Depotit Accoanti.
Internet Banking Service
ii you
selectecito receivilnMmet Banking Services, you understand that you will be required-to enter. into a
separate Internet Banking ServiceS.Agreenient with 013TCAbefore.you can access the Internet:Banking SonAce.
Acknowledgernent of Receipt of frivaCy Notice
By signing below you acknowledge receipt of OBTCA's •Pinracy Notice included in the Application Package.
Non-US Individuals: Confirmation of Tax and Compliance Responsibilities.
.
.
You confirm that it is.eti responsibility to l elf 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 yourtuainess relationship with.DEITCA.
NOn-U.S Organizations.: Confirmation of Tax and COmpliance Responsibilities;
You confirm that it is your responsibility to felt any tax Obligations and any other regulotorY reporting duties applicable
to it in any relevant jurisdiotiOris that may arise in connection with assets, income or transactions in youtacCount(s) and
your business relationship with MICA. Furthermore, you content. that the neisessary information (to the bait cif yout
knowledge and capabilities).is made available no less than annually to the felevant.beneficial owner(s), sonleas).
beneficiary(ies). Panner(s). etc. to enable himnier/ them to fulfill any respective taxobligations that may arise for hint/heti
these in connection With-your business-relationship with OBTCA.
Please complete and attach sepereteW4 or W-9 documentation esappiicable::
Terms and .Conditions. and Representations .
.
.
.
.
By signing below, you acknowledge receipt of the Turns and Conditions lot Deposit AcCotints attached to. this
AppliCatIon and agree to babciund by them. In addition..yonegree to nobly us immediately of any material Change to,
the inforination provided byyou on this Application.
-You represent aril warrant that all of the information provided by you on this Application is accurate.
The Terms and Conditions fOr Deposit Accounts are subject-to change.
Accep9nce".—Th
Yoy aderite
eattiOn itaubieCt to
-
by
Joint Account Molder'sScripture
For
Opty
Da
'-
Accept
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CONFIDENTIAL
SDNY_GM_00038482
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001306
EFTA_00149091
EFTA01282887
fi
f
c
IN WITNESS WHEREOF, the undersigned, by and through its authorized officer, has caused this instrument to be •
executed on the detonated below.
[FOR.13pSlilES USERS[
_Southern Treat
Inv
(FORAWOT.HEhlUSERS)
.
,
.
1.h. mom.
:21
CONFIDENTIAL
.94Ya4:01,2
.:egiteseeitt3
SDNY_GM_00038483
CONFIDENTIAL — PURSUANT TO FED R. CRIM. P. 6(e)
DB-SDNY-0001307
EFTA_00149092
EFTA01282888
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