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efta-01362294DOJ Data Set 10Other

EFTA01362294

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Unknown
Source
DOJ Data Set 10
Reference
efta-01362294
Pages
1
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a. Name and Title of Natural Person Opening Account: Darren K. Indyke, Treasurer b, Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: I Gratitude America, Ltd., a U.S. Virgin Islands not-for-profit corporation and 501(c)(3) private foundation I 6100 Red Hook Quarter, B3 St. Thomas, USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name Date of Birth Legal Address For V.S. Persons: Social Security Number For Nal-US. Fermis: (See Immo:el for alternatives' to So6al Semeity Number) Not Applicable 1 For Nen-U.S. Persons. in 00Chhal to a Social Security Number ore Paieeport Number with Country of leathers* an alien identificationodd number, or hernber and counny of taktanC4 of any other government. issued document evidencing nationality of residence and bearing a cewitograpti or Barad set:guard should be prciftec, (if no individual meets this dolinitlivi Mecca Mite 'NM Aaa4Caal0.1 d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as: • An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer. Chief Operating Officer. Managing Member, General Partner. President Vice President. Treasurer); or • Any other individual who regularly performs similar functions. (if appropriate, an Individual listed under section (c) above may also be listed in this section (d)). Name DO:a of 84th Lea Adecess For US. Persons: i For Non-U.S. Persons: Social Security (See footnote 1. for altar:views! ' Number I to Social Seemly Number) Darren K. indyke 02/18/1985 2 Kean Court, Livingston, NJ 07039 For Non-U.S, Pe sons. inmidden to a Social Security Number ore Passport Number yeah Canny of issuunctr, w alien identificatson card number, or number and country of issuance of any other goverment-issued document v.:Centel notionality ce residence and beering a photograph or similar safeguard skald be nrcvioed. I. Darren K. Indyke (name of natural person opening the account), hereby certify, to the best of my knowledge, that the information p ided above Is complete and correct. Signature Legal Entity Identifier (OpliOntli) August 15, 2018 Date 02016 Deutsche Dank AG. Al Fights reserved. 94818.5666 026819.051318 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0051656 SDNY_GM_00197840 EFTA01362294

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