EFTA01392670

ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service If you have selected to receive Internet Banking Services. you understand that you will be required to enter into a separate Internet Banking Services Agreement with D87CA before you can aocess the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below. you acknowledge receipt of DB7CA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responcibility to fulfill any tax obligations and any other regulatory reporting duties applicable to you in any relevant jurisdictions that may arise in connection with assets, income or transactions in your account(s) and your business relationship with DBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may arise in connection with assets. income or transactions in your account(s) and your business relationship with 067CA_ Furthermore. you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner4s), settlor(s). benefician(ies). partnet(s), etc. to enable him/her/ them to fulfill any respective tax obligations that may arise for him/her/ them in connection with your business relationship with MICA. Please complete and attach separate W-9 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to this Application and agree to be bound by them. In addition. you agree to notify us immediately of any material change to the information provided by you on this Application. YOu represent and warrant that all of the information provided by you on this Application is acctilate. The Terms and ConeIlia for Deposit Accounts are su 7 Accept nce You nderstand that this - • pI is subject to act b change. ante by 087CA. nt Holder's Signature Joint Account Holder's Signature Rijitati!‘ , 8: ey, 1--• ererzue "I, M iwJe ttir ":3:19R ittinegitte Et.b. .,501) '4 .2-7tircmismgc-st.lte tfort ttscieliibisim..S,-4:`,.c 4, . ..4 W%1•6.- --z-ta„,g - ..- t4..t7 c4W,,?„..41.4.4 • iteeZearetse 4411 .:;')-teWt:ril,"•:•••;:40r,"1"‘ :Ire cpsita?:W if, V.I.p..,44 .‘r • <:'4 4;•.:4h .. . ., 01:Cetni0;brilil pi* a : . ,A03 Date Date ; 3Age, ,:onnuota p,aiativa ‘•,,,trzv c.arYsetw‘sitzsotriasiatf4c: trimipap4p. teke„.f.c.i, .77 w " 7.2."' eThWPRitiWifitAite:4au est, Le...,*;........r .,t,..n . •Intet r .m ;ace? i et .4 V.41 ntrwl -,2*-aii:mir,rps:4-7.41%-era:Arttely*"..akc • 41;*).944. qfNWPAW:Vpairg 4 ;42fe.'ef • ri • 4 41.417•41;ri , :Se yvt.cse -,Nuc, w, n ;o a -frrit"Sk Easani z iaggat- 3 13.AWW0101 41e 013959.032613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0097931 SDNY_GM_00244115 EFTA01392670