Case File
efta-01387991DOJ Data Set 10OtherEFTA01387991
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01387991
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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' , oc': es,
ndividual's Name
Date of Birth:
Country of Residence
Country of Citizenship'
Address of primary
residence-
-4as C ert rescec c.aside
of hisiber country of
nationality for 5 years or
more?
Yes t
No
Profession, Occupation
N A
Tax ID: SSN
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
.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
g 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
OYes
RN°
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 (soecityt
Dare
o
O
iii
O
O
•
D
O
0
nWealth Details for this individual are rot fi led o because they are :he same as for the following person.
3B. Wealth Details (Only for parties recur 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 Mdustry of source of Wealth/Source of
Funds?
Summarize Source of Wealth:
11 Business Coen., O Salary/Earnings • Investment O I nhentance/Glts
J Other:
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0091296
SDNY GM_00237480
EFTA01387991
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