Case File
efta-01428153DOJ Data Set 10OtherEFTA01428153
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01428153
Pages
2
Persons
0
Integrity
Extracted Text (OCR)
EFTA DisclosureText extracted via OCR from the original document. May contain errors from the scanning process.
11. Certification of beneficial owner(s)
Persons opening an account on behalf of a legal entity must provide the
follovwing 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: ■
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c. The following information for each individual, if any. who. directly or
indirectly, through any contract, arrangement,
understanding, relationship or otherwise, owns 25 percent or more of the
equity interests of the legal entity listed above:
Name
Date of Birth
Legal Address
For U.S. Persons;
Social Security
Number
For Non-U.S. Persons:
(See footnote 1 for alternatives
to Social Security Number)
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' For Non-U.S. 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 any other government-issued document evidencing
nationality or residence and bearing a photograph or similar 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)).
EFTA01428153
Name
Date of Birth
For U.S. Persons:
Social Security
Number
For Non-U.S. Persons;
(See footnote 1 for alternatives
to Social Security Number)
Legal Address
• For Non-U.S. Persons, in addition to a Social Security Number or a
Passport Number with Couiitiv of Issuance, an alien identification card
number, or number
and country of issuance of any other government-issued document evidencing
nationality or residence and bearing a photograph or similar safeguard should
be provided.
(name of natural person opening the account), hereby certify, to the best of
my knovt/iedge. that the information provided above is complete and correct.
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Signature
Date
"/// "
Name (Print):
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Legal Entity Identifier (Optional)
02018 Deutsche Bank-AG. All rights reser\'ed. WM189666 026819.051318
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7
EFTA01428154
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