EFTA01282889

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Ot,Survivore • ' ./011.7,99Ps lh i•ofttr. 0 in Trust ForlPatiabie on. Deethhks "trustee for K Trust • Estate ▪ ti-010011"#.40.11Y. C:1 Founcluk, O Nonligattruaninuon . Aftprie.i trai Esefoi; Lafidictid MineEscigw 4 ,#)o#48Ith.Poriurnim. • cosipsti.cebxoiro 9 • • 40.iiif#####iii*P01:90iok • sulk*e D.brt cos # K °!#iic#SsieSio01iii### O : Name Orgy: Q. NinietakIrfAOOrees O gyoKplestf=erh,pt dor stew " ZIP COO K 0eilingoildreee fif.ditleren0 .• . • • • 'Addy . . eity. Staff) Zip Code ...DorPerition ..:Ptij#0. .Q OW* L146.11ftlichsii!** 6 CONFIDENTIAL NA080D00014td4,0000a1e24 9.916:#32#1.1 • SDNY_GM_00038484 CONFIDENTIAL - PURSUANT TO FED R. CRIM. P. 6(e) DB-SDNY-0001308 EFTA_00149093 EFTA01282889 Home lele DOOM, Manlier Account Title and Joint ApplijiatienInfontifitizin Southern Financial LLC • • • Name of -AcCoioulide . 1:NintAfilfijr*l last name, lest name. middle Satialor Business 'fisetteme, first name. middle initial) • • • Social Socunty Menem a taxpayer ID Sturntrat Social Security NuMbir or Thspayet ID NOMIS _6100490-SPICSIINIthl-P-4.. • • • Addresi Address' . • . Cnv. Slate OM• • • • • • Clly:StillObild Zip Coda' Elvsinssa Telephone Mimeo:eh 2SITEIVa013 Daticif With Tekptgne • Name of Empleysr Shaff fAllano!OY" . Aetna Addteis City; State and-ZTip Cede- . •Caty, State and Code " ' Noticeof Customer Identification Policy Important Information To help the-government fight Milfunding of ternsiiimend Monet; launderifwg activities, Federal law imitates an financial institutions. obtain, Wirityzind- record infwmbtion that identifies each persOnWho establishes' an. or other biisiness relationship with a finartciat institution. This means that we will salt for your name, address: and other 'information that with allow we to identity you: We may also ask-to see identifying docureents such as a certificate of: formation Of good standing (ledal. entities) or a passport or. otha! photo identification juidieldnals). '3rd-EU Notice • Governmental rules have also broadened the scope'Of the Bank-sobtigations io the fight against:money letindedep and teircaristlitien6ng;:these rules call loran activelninsivernent of both asset management lima and their clients. For new and existing clients we currently have a -legal obligation to: ask ow customers questions regarding their identities; addresses. source of funds and. if necessary, legal representatitres, authorized: signatories, beneficial owners or control structures and to collect requisite documentation te.ehtelantiate.the information: Also, enhanced anti-money laundering reqUirementi require that ehquid any of, the aboiie persona! Or institutionalinformation Ahanpk OWteams would be. .. °Wiped so immediately notify the dflantle(1) endpreyideps 4yitlYreilayantdocuriMmetlaeto Verillifho.so changes. Telephone, Facsimile-or Email InstructiOnS By Sighing-L*6w: you agree that from erne to time you may give instnictioni by ielephone, facsimile a email regarding the above OW-foiled eccourfitil (defined herein as "Verbal Instructions'). his understood that the risk of Verbal InStruetions being given chi person of persons purported lobe you is-yOtir own. Absent the gross negligence-or willful misconduct of.Deusche.Bank Trust Company Americas (OBTCA),. yOujagroi to indemnify and hold harmless OBTCA for any:claim's, lases, expenses; cdits-or attorneys' fees resulting treat OBTCA's acting upciA such misunderstood 'end unauthorized Verbal Instructions. You understand that DBTCA.Mate. but stallnot be' requited. !teak verifieetierief your • verbal, facsimile or email instructions Wish back. In case of doubt, OBTCA may in its sole discretion refuie to execute your Verbal lnstructions or any part thereat without lncurrino any liabilay..DOTCA is under-no Obligation:IA*4c* your • :Verbal Instructions to transfer funds or seCorities to any accounts) withog!*tition insfitzedonsOereing your original signature. Joint Account Disclosure You have opened }clot account with OBTCA and acknovAedge receipt of :ilia lellosieTng.inforinitlon• This deposit end any additions to the account shah become.the properly of eaChowner es joint tenants, and.DBTCJ1 may release the entire- account to any owner during the lifetime of all owners: DEITCA may bailor checks, Ordeei or Withdrawal requests horn any owner Owing the biotin* of all owners. The Bank may be required by service of legal probase'fnrenlit funds held in. the joint accoum to satisfy a judgment ehlered.against. or other valid debtincurred tiNi:ariy owner of the account. DENG\ May honer checks. orders: or withdravial requests from. the survivors) eget the death of any owners) and may treatthe account as the sole properly-of the survivors) alter the death-of any (wineds). Unless DBTCA receives withertnetice • signed by any owner not to pay W. cilinjor any join; deposit or addiliwtoi acornak.D.BTCA shill not be liable to any Owner. :for continuing lo honor checks: orders or withdrawal requests-from any owner. After. ine.receitztof the eutice.rpfenred 10 in the previous sentence, OBTCA-mayrequint the Written euthorization.ol any or atiorni °Whirs:fin lig:hefted' PSYMehea or deliveries. 2 13.0040101 0i3S59.0326t3 SDNY_GM_00038485 CONFIDENTIAL CONFIDENTIAL — PURSUANT TO FED R GRIM. P. 6(e) DB-SDNY-0001309 EF1'A_00149094 EFTA01282890 ir ATM/Debit: $eMce 'Matadi& 'Illgtil*letentioneuOtti Ctl.dwATIvlaibit card conetistis 4e:enplanes oftOterms and conditions of the AgreamentiOgriteinsidlit'llie TOSiiiand COnditioni.ed. DepOsit - Internet Barlking.SerViCe. Ityou haw selected to receive Internet flanking:Services. You understand that you will be reisuliad to error into a lapareie:Mtemet•ganIdng.Senrices Agreement with DBTCA before you can access the Internet Banking Service. Acknowledgement Of:Receipt of NO./icy Ncitice By signing biknie, you adknoWledge receipt of iNfTeks Pii6aCy Notice included in the ApPlii-aV0.9 Package. Non-US Individuals: Confirmation of*Te?tancl•CornplianoefiesponSibilities, You confirm that it is youi teipptiSibility-to fulfill any tax tibikkitions and any other. •regulifory reporling duties applicable. Is you ;II any relevant juriauticete :Set may arise in Canitiotl6h:With assets; income or tranaSetionsksyoui itecciss(s). and yOur business bilgibbshib-wo DBTC,A. . . • .. • Non-US OtoanizatiOnt:-.Confiernation'of Tajc:and Compliance Responsibilities. Yinknotifilm that it is Youi resiionlibilitY.tolunili any lug ohligeiioria and any other regulatory reporting Duties applicable CO it in' nyTrelevantjulisdintions that may arise' in connection with assets; iricorrieottiatisections juyourtitecising(s) and Yout bOilneas relationship with 001CA. Eurtherrignu.yeni cOnfirth thatthe .necasearyInforriiationAto the best Oil SOO/. knowledge and capabilities) is made available no re.“ than annually to. the relevant beneficial tie/Sale). tuitikSe(11: benefielitry(ies),,panniy(t),:et to enabletiithater/ them to (OM any respobtiva Uli Obligalkins that may arise far hirii/hari. *OM Ucconnection your busin'e'ss relatiOnship With:DEiTCA. • . Please complete and attach separate W:78 et W:P clothirpeptetiphas 106dd/ie.. Terms. and Conditions and Representations . .. . . .. . . .. .. . . . By Mining below you acknoWleilge receipt of the:Ternis end Conditions ki.OUSIOWASIourits attached to this APPlicatIcin and agree to Si bOun0 bythern: Intiddition:YoUattietto notify us inwriedlaiely of anymateriel changeUS die information provided by you on this AppliCatiOn. You represent and that all of the infoiinatlisn Provided by you On thiS Aeolic:Won illaiaisid. The Terms and Conditions for Deposit Acceuntsam so •jectio change. Athapta YOu *triad by. oerrcA. Saint .t fleasect stratus — •Ie: • • Onlir Reviewed by. Far Na "•":. uato btu Date At • by DATCA: -71/1A-JEC-7CAC ("..410C .Date CONFIDENTIAL 1 SAWM-010I 013959 032013 SDNY_GM_00038486 CONFIDENTIAL — PURSUANT TO FED R. GRIM. P. 6(e) DB-SDNY-0001310 EFTA 00149095 EFTA01282891