Case File
efta-01379165DOJ Data Set 10OtherEFTA01379165
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01379165
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
EFTA DisclosureText 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
b. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened:
c. The following information for each individual, if any, who, directly or indirect€y, through any contract, arrangement,
understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above:
Name
Oate of Birth
legal Address
For V.S. Persons:
Social Security
Number
For Non-U.S. PereJOE
(See footnote I for alternatives
to Social Security Number)
For Non-US. Persons, in ereditcon to a Social Security Number or a Passport Number with Country of Issuanot an alien identification card number, or number
and country of issuance of any other government-issued document ewJencing nationality or residence and bearing a photograph of sink', safeguard should
be provided.
(If no individual meets this definition please write "Not Applicable')
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
Date of Birth
legal Address
For U.S. Persons: I For Non-U.S. Persons:
Social Security
(Set footnote I for imernattves
Number
to Social Security Number)
• For Non-US. Persons, in addition to a Social Security Number or a Passport Number with Country of Issuance. an alien identification card number. or number
and country of issuance of anyOther gOvernrnent-IsSued*DCument thidencIng nationality or resloence and bearing a photograph or similar safeguard should
be provided.
(name of natural person opening the account), hereby certify, to the best of
my knowledge, that the information provided above is complete and correct.
Signature
Date
Legal Entity Identifier (Optional)
e 2018 Deutsche Ban( AO. All rights received. WM189666 026819.0.5101S
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
SDNY_GM_00222669
DB-SDNY-0076485
EFTA01379165
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