Case File
efta-01355694DOJ Data Set 10OtherEFTA01355694
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01355694
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (1) CLIENT HAS RECEIVED. READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION. AND (2) THE INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS ACCURATE.
CLIENT Ad( Wilats bud-tint ACCOUNT AGREEMENT CONti4NS'TilTAttialitriOifiVirloti
Stelli3N
PAGE 5. AND ca,teic,
AGREES TO IT
ERNS IALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL),
.
INITIAL HERE:
THE INTERNAL REWENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP WITHHOLDING, AND, IF APPLICABLE, THE CERTIFICATION REQUIRED TO ESTABLISH CUBITS STATUS AS A NON-US.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Information for ERISA employee benefit plan clients: U.S. Department of Labor regulations reeler° NV to disclose to a responsible plan fiduciary
certain information in connection with the services that 0651 provides to a plan, to assist the fiduciary in evaluating the reasonableness of DBSI's services and
related compensation. The disclosure is available online, at lutpc/bmwv.pwm db eorNamericas/en/erisa disclosum_poshtml. By signing below, you acknowledge
that you area fiduciary responsible for the procurement of DBSrs services to the plan, you have read the asclosure end you understand the disclosure.
Individual or joint accoobt 11F THIS IS AJOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable in any relevant jurisdictions that
may wise in connection with assets, income or transactions in Client's account(s) end business relationship with OBSI.
CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
Tenants in common, or
Community Properly for married couples in certain states: each spouse retains 50% interest in the community property upon death of the first spouse).
Signature
Date
Print Name
SSWEIN
Signature
Date
Print Name
SSN/EIN
Signature
Date
Print Name
SSIVEIN
CorperretiOn, athrierinip, trust or other entity:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILMES
.
. .
.
Client acknowledges having solo responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions
that may arise in connection with assets, income or transactions in Client's account(s) and business relationship with DEISI. Furthermore, Chant confirms that the
necessary information Ito the host of Client's knowledge and capabilities) is made available no lam than annually to the relevant beneficial owner(s), settlorts).
.beneficiary(ies). partner(al. etc. to enable such percents) to fulfill any respective toss obligations that may at M for Such PcfPrIalk1.00IMASTi9P Wit, Client's
business relationship with Des(.
66-0629193
Nome of cnlity Jeepers. Inc
* Pinar
No.
Officer,,
TrUsteg, Atehodatil
Oaf. Qtill
( is
Print Narneffitle3effreT Epstein•
ere, Si Cie .4.
Signature of Officer, Penner. Trustee, Authorized Party
Date
Print NerneMtle
Signature of Officer, Partner. Trustee. Authorized Party
Date
Print Name/Title
13.AWLI.0196
7
012145 032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0040946
CONFIDENTIAL
SDNY_GM_00187130
EFTA01355694
Technical Artifacts (6)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
SWIFT/BIC
ACCURATESWIFT/BIC
APPENDIXSWIFT/BIC
APPLICATIONSWIFT/BIC
CONTAINSSWIFT/BIC
INFORMATIONSWIFT/BIC
SIGNATORIESForum Discussions
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