Text extracted via OCR from the original document. May contain errors from the scanning process.
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DBTCA Deposit Account Opening Application
Private Wealth Premium"
Elite Personal Accounts
O Checking Acct.
O
Elite Checking with Interest
Acct. N
APY
O
Elite Money Market Deposit
Acct. ft
APY
O
Certificate of Deposit
Acct. N
APY
Term
O
DB AG NY Preferred
Certificate of Deposit
Acct. N
APY
Term
Promo term
(DBTCA deposit account required.
along wan a 08 AG Preferred Terms
and Conditions)
Private Wealth Premium
Internet Banking Services
G6.0B Private Wealth Online Plus
O
Link to Existing Online Relationship
Din)(5 -0
Walk.° ID Number)
Client Relationship
O Individual Account
O Joint Tenants with Right
of Survivorship
O
Joint Tenants in Common
O In Trust For/Payable on
Death/As Trustee for
O Trust
O Estate
Private Wealth Premium'
Elite Business Accounts
0
Checking Acct. N
V2(95-115
Ci2
K
Elite Checking with Interest
Acct.
APY
O
Elite Money Market Deposit
Acct. 00113n5S -2,
Apy
K Certificate of Deposit
Acct. It
APY
Term
O OB AG NY Preferred
Certificate of Deposit
Acct. N
APY
Term
Promo term
(DBTCA deposit account required.
along with a D8 AG Preferred Terms
and Conditions)
O
Cash Master Sweep Account
Checking Acct. II
Private Wealth Premi :m74
Banking Services
O Consumer Debiti ard
O
Joint Applicant (titbit Card a
O
Business Debit Ci,rd N !
K
Deluxe Checkboriz Style a
O
Name Only
O
Name and A.: Ideas!
O
Duplicate Statem int
Addr
City
State
L p Coda
D Mailing address ( I different)
Name
Addr
Erne Money Market Deposit
Acct.
APY
Target Amount
Trigger Amount
0
Custody under NY UTMA
O Foundation
K
Non.Prof it Organization
O
Attorney Trust Escrow
O
Landlord Master Escrow
City
State
ZitrCodti
O Corporation
O Limited Liability C
ny
K Partnership
O Limited Liability P, innership
13-AWM-0101
NAOSOD000156 SO-00010513S
0%3959 .032613
CONFIDENTIAL - PURSUANT TO FED. R. CRI M. P. 6(e)
DB-SDNY-0001470
EFTA_000 14944
EFTA00165728
Account Title and Joint Application Information
Butterfly Trust
Name of Account Title
Oast name. first name. middle initell or Business
264639711
Social Security Number or Taxpayer ID Number
Social Security Number or Taxpayer ID Number
6100 Red HookStuartar B.1
Address
Address
-fifins Applicant
(lest name. first name, middle initial
_Si—Thomas
U.S. Virgin Isle 00802
City, State and Zip Code
City. State and Zip Code
Zei)
j3110) 41-c -F5-2s-
HormaTate
Number
Home Telephone Number
ph
(2{x)9
I " ‘,3 0 ( p
Business Telephone Number
Business Telephone Number
27/dect2006
Date of Birth
Date of Binh
Name of Employer
Name of Employer
Address
Address
Not applicable
City. State and Zia Code
City, State and Zip Code
Notice of Customer Identification Policy
Important Information
To help the government fight the funding of terrorism and money laundering activities, Federal taw requirei all financial
institutions to obtain, verify, and record information that identifies each person who establishes an account investment or
other business relationship with a financial institution This means that we will ask for your name, address. 3nd other
information that will allow us to identify you. We may also ask to see identifying documents such es a cont .:cat. of
formation or good standing (legal entities) or a passport or other photo identification (individuals).
3rd EU Notice
Governmental roles have also broadened the scope of the Bank's obligations to aid in the fight against mo ley laundering
and terrorist financing: those rules call for an active involvement of both asset management firms and theit clients. For
new and existing clients we currently have a legal obligation to ask our customers questions regarding the e identities,
addresses, source of funds and, if necessary, legal representatives, authorized signatories, beneficial owne • 3 or control
structures and to collect requisite documentation to substantiate the information. Also, enhanced antemor sly laundering
requirements require that should any of the above personal or institutional information change, our clients ,vould be
obliged to immediately notify us of the change(s) and provide us with relevant documentation to verify the:.a changes.
Telephone, Facsimile or Email Instructions
By signing below. you agree that from lime to time you may give instructions by telephone, facsimile or en oil regarding
the above captioned accounts) (defined herein as 'Verbal Instructions"). It is understood that the risk of VI 'bal
Instructions being given by person or persons purported to be you is your own. Absent the gross negligamn or willful
misconduct of Deusche Bank Trust Company Americas (DBTCA). you agree to indemnify and hold harmless OBTCA for
any claims, losses, expeosns. costs or attorneys' fees resulting from DBTCA's acting upon such nnisunders-iiod and
unauthorized Verbal Instructions. You understand that DBTCA may. but shall not be required to, seek verifi :3tinn of your
verbal. facsimile or email instructions by call back. In case of doubt. DBTCA may In its sole discretion talus Ti to execute
your Verbal Instrucdnns or airy port thereof, without incurring any liability. DBTCA is under ne obligation to execute your
Verbal Instructions to transfer funds or securities to any account(s) without written instructions bearing yot r original
signature.
Joint Account Disclosure
You have opened a joint account with DBTCA and acknowledge receipt of the following inlormation: This c °posit and any
additions to the account shell become the property of each owner as joint tenants, and DBTCA may relent tha entire
account to any owner during the lifetime of all owners. DBTCA may honor checks, orders or withdrawal re( nests Iron,
any owner during the lifetime of all owners. The Bank may be required by service of legal process to remit funds field In
the joint aecount to satisfy a judgment onteied against, or other valid debt Incurred by, any owner of the at count. DBTCA
may honor checks, orders or withdrawal requests from the survivor(s) after the death of any owner(s) and r • ay treat the
account as the sole property of the survivor(s) after the death of any owner(s). Unless DBTCA receives wrist 'n notice
signed by any owner not to pay or deliver any joint deposit or addition or atonal, DBTCA shall not be lastile 'to any owner
for continuing to honor checks, orders or withdrawal requests from any owner. After the receipt of the noti. refeiled to
in the previous sentence. OBTCA may require the written authorization of any or all joint owners for any fur her payments
or deliveries.
2
11*W/4.0101
013959.032813
CONFIDENTIAL - PURSUANT TO FED. R. CRI M. P. 6(e)
DB-SDNY-0001471
EFTA_000 14945
EFTA00165729
ATM/Debit Service
You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and Condit ms 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 eon into a
separate Internet Banking Services Agreement with DBTCA before you can access the Internet Banking S !mice.
Acknowledgement of Receipt of Privacy Notice
By signing below, you acknowledge receipt of DBTCA's Privacy Notice included in the Application Packer
Non-US Individuals: Confirmation of Tax and Compliance Responsibilities..
You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting du _es applicable
to you in any relevant jurisdictions that may arise in connection with assets, income or transactions in yet r account(s)
and your business relationship with DBTCA.
Non-US Organizations: Confirmation of Tax and Compliance Responsibilii ies.
You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting du '.es applicable
to it in any relevant jurisdictions that may anse in connection with assets, income or transactions in yours xourills) and
your business relationship with DBTCA. Furthermore, you confirm that the necessary information (to the t
of your
knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s), se Ilor(s),
beneficiary(ies), partner(s). etc. to enebte him/her/ them to fulfill any respective tax obligations that may al se for him/her/
them in connection with your business relationship with OBTCA.
Please complete and attach separate W-8 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 a this
Application and agree to be bound by them. In addition, you agree to notify us immediately of any materii I change to
the information provided by you on this Application.
You represent and warrant that all of me information provided by you on this Application is accurate.
.
The Terms and Conditions for Deposit Accounts lie subject to change.
Acceptance
You understand that this applicat
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13.PWM-0101
013959 032613
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001472
EFTA_000 14946
EFTA00165730
IN WITNESS WHEREOF, the undersigned, by and through its authorized officer, has caused this ins trument to be
executed on the date listed below.
]FOR BUSINESS USERS'
Butterfly Trust
.O9erneSSN kink,
Darren Indyke/ Trustee
tame/Ties:
hig*. 404!
OEUTSCti6 BANK TRUST COMPANY AMERICAS
Print Name/Title
la i
Da
(FOR ALL OTHER USERS]
Richard KahrdTrus
/I toM ..m
Account Name
Nanienitle
gnature
21
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WMI34667
0%01%O30613
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001473
EFTA 00014947
EFTA00165731