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efta-01387990DOJ Data Set 10Other

EFTA01387990

Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01387990
Pages
1
Persons
0
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details 'a ' a. cc': esi ndividualt Name: Date of Birth: Country of Residence Russan Federation Country of Citizenship: Russian Federation Address of primary residence- Begovaya Street 24 Apt 3 Moscow NA Russ an ceceration Has client resided outside of his/her country of nationality for 5 years or more? CI Yes R No Profession, °coupe; ion N A Tax ID: SSN 722993433 Current Employer: N A Position/Title( Rank NSA Address of employer: N A Does the person work as senior executive of a DB-recognized regulated entity in the financial Industry? or a entity listed on a OB-recognised exchange? (Not applicable for operating entities Oyes ri No is the individual a Politically Exposed Person (PEP)7(i( Yes. describe) N/A Yes a - .4 No To the best of your knowledge, lathe individual related to an employee of the DB groupWif Family or Friendship, describe) N/A I,,,,) Family O Friendship Vi None To the best of your knowledge, is the individual party to a non-banking relationship with Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or services)?(if Yam/nate ) WA O vas 10 No If applicable. indicate which bank officers have met the person Indicate where and when the client meeting(s) took place Bank Officer Narne(s) Bank Office Client Private Domicile. Client Place of Business Other Location (soecifyi Dare o O I O O D O 0 nWealth Details for this individual are rot fixed n because they are :he same as for the following person. 38. Wealth Details (Only for parties 'eau., ng source of wea':h descrIption as Ind cated in Section 2) Nature of the Individual's Business: Primary Country of source of wealth/source of Funds? Primary fldustry of source of Wealth/Source of Funds? Summarize Source of Wealth: 1.11 Business Owner O Salary/Earnings • Investment O Inhentance/Glts J Other: CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0091294 SDNY GM_00237478 EFTA01387990

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