Case File
efta-01365769DOJ Data Set 10OtherEFTA01365769
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01365769
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 (21 THE INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS ACCURATE.
[
AGREES
CUENT
TO
EDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE DISPUTE ARBITRATION CLAUSE AT SECTION III, PAGE 6. AND CLIENT
MS (ALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL).
INITIAL HERE:
1;
THE INTERNAL REANUE SERVICE DOES NOT REOUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP WITHHOLDING, AND, IF APPLICABLE, NE CERTIFICATION REQUIRED TO ESTABLISH CLIENTS STATUS AS A NON-U.S.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Information for ERISA employee benefit plan clients: U.S. Department of Labor regulations require DBSI to disclose to a responsible plan fiduciary
certain Information in connection with the services that DBSI provides toe plan, to assist the fiduciary in evaluating the reasonableness of DBSI's service and
related compensation. The disclosure is available online, et httpilevw.pwm.db.corremerices/enerisa_disclosure_pcs.html. By signing below, you acknowledge
that you are a fiduciary responsible for the procurement of DB51's services to the plan, you have read the disclosure and you understand the disclosure.
Individual or joint account (IF THIS IS A JOINT 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 arise In connection with assets, income or transactions in Client's accounts) and business relationship with DBSI.
CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
O Tenants in common; or
Community Property (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
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Signature
Date _
Print Name
SSWEIN
Corporation, partnership, trust cc other entity:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole 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 eccount(s) end business relationship with DBSI. Furthermore, Client confirms that the
necessary information (to the best of Client's knowledge and capabilities) S made available no less than annually to the relevant beneficial owned.), aettlor(s),
beneficlary(ies), pennies). etc. to enable such person(s) to fulfill any respective tax obligations that may arise for such parson(s) in connection with Client's
business relationship with
Jeepors. Inc
Marne of Entity
Employer ID
Signature of Officer, Partner. Trustee, Authorized Pa
Print NametTnle Jeffrey Epstein
c, a<KI.
Da,
;
Signature of Officer, Partner, Trustee, Authorized Party
Date
Print Name/Tele
Signature of Officer, Partner, Trustee, Authorized Party
Date
Print Name/Title
13AWM-0196
7
012145.0321113
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0056852
CONFIDENTIAL
SDNY GM_00203036
EFTA01365769
Technical Artifacts (7)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
SWIFT/BIC
ACCURATESWIFT/BIC
APPENDIXSWIFT/BIC
APPLICATIONSWIFT/BIC
ARBITRATIONSWIFT/BIC
CONTAINSSWIFT/BIC
INFORMATIONSWIFT/BIC
SIGNATORIESRelated Documents (6)
DOJ Data Set 10OtherUnknown
EFTA01682184
186p
DOJ Data Set 10OtherUnknown
EFTA01370863
1p
Dept. of JusticeOtherUnknown
Medical Record/Clinical Encounter: DOJ-OGR-00026334
This clinical encounter document from the Bureau of Prisons details a medical evaluation of Jeffrey Epstein on July 12, 2019. It covers his medical history, current complaints, and treatment, including discussions around his triglyceride levels, sleep apnea, and back pain. The document was generated by the treating physician at the Metropolitan Correctional Center in New York.
1p
DOJ Data Set 8CorrespondenceUnknown
EFTA00014087
0p
DOJ Data Set 11OtherUnknown
EFTA02367961
1p
DOJ Data Set 10OtherUnknown
EFTA01977826
2p
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