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May. 8. 2014
3:31PM
Ashford at Spring Lake
No. 1296
F.
TD AMERITRADE
Paulina Sepulveda
Investment Consultant
16830 Collins Ave I Sunny Isles Beach, Florida 33160
Fax Number.
MIA 92386
Facsimile Transmittal
Fax
Re: Forms Client Requested via Fax
Pages: 4
CC:
K Urgent
0 For Review
3 Please Comment
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CONFIDENTIALITY NOTICE: This facsimile transmission is intended only for the use of the
individual or entity to which it is addressed and may contain information that is privileged.
confidential and exempt from disclosure under applicable law. If the reader of this transmission is
not the intended recipient, or the employee or agent responsible for delivering the transmission to
the intended recipienL you are hereby notified that any dissemination, distribution or copying of
This communication is strictly prohibited If you have received this communication in error, please
notify us immediately via telephone or facsimile.
TD AMERITRADE, Division of TD AMERITRADE, inc., member F!NRA/SIPC. TD AMERITRADE
is a trademark jointly owned by TD AMERITRADE iP Company, inc. and The Toronto•Dominion
Bank. O 2008 TD AMERITRADE IP Company, Inc. All rights reserved. Used with permission.
EFTA00283674
May. 8. 2014 3:37PM
Ashford at Spring lake
No 1296
P.
Ernie AddreaS (reqtann tor egecfronic &Wary Of
your account Mama,* and trade conirmations):
ID Amentrade
PO Box 2209 a Omaha, NE 68103-2209
Fax:
Questions' Call a Client Services representative at 800.869.9900.
['Update to an existing account O New account
lfe of tntiy:
Southern Trust Co, Inc
Entity Authorized Agent Form
Elusions Address.
(no pi) box 0.modrop) 6100 Red Hook Quarter 83
Ciy.
St. Thomas
alakx
USVI
ZIP Code:
0 0 8 0
2
Milling Address:
(iNiff vont born above)
Cap
ZIP Cot:
Secondary Ptearec
Fax Number.
U.S. Entry OFireign Entity - Country CI Formation:
(c0mPlete appropriate Rim W-8)
TypedBusiness;
Consulting
If this is a bust account. pYease spec name of Grantor and date of toast:on:
SlateThOeinCa of FonrotionfOrgarazation.
United States Virgin Islands
Is this a Pooled investment Vehicle? Ely. ao
Ira Corporate accomt. please indicate if this e en SCorporatloi by checking here..O
If this emay is a pub`cly traded company, please s ecify the stock symbol:
2. AUTHORIZED AGENT/PARTNER/TRUSTEEIOFFICER INFORMATION
Peek(
ID Mr D'ArS. Oa. OD: °Rev.
Full Legal Name:
Jeffrey Epstein, President
Date of Seth:
(M4:10-YYYY)
Home Adders
filo PO bow or meg drop
U.S. toast Secutity Melte(
(SSt0
oar.
St. Thomas
Please specify it you a-a
DUnemployed ORetired OllometnaSm ❑Student OSelf.EmplOyed
Errarbyer Marne:
Southern Trust Company, Inc.
ern0lcnrer Sliest Address.
Stale:
USVI
ZIP Gods.
Source of income rat wind otunduniciord):
Financier
Occvgatiortrrype of Sushi=
Financier/Consulting
csy
St. Thomas
If none, please submit a pholc00py of your passpat.
IIIIIIII
State:
USVI
L
zPcooe.
Pal.) 1 ol 3
Tea '.1$7F IN12
EFTA00283675
May. 8. 2014 3:37PM
Ashford at Spring Lake
No. 1296
P. 3
Prefix:
OW Deers. OtAs UT). tip:.
Full Legg WOW.
Date of SAE
(R1M-OCNYVYY)
Horne Address:
foe PO box or madras))
t1S.Socied Secuny Number:
(SW'
ety:
Stare:
ZIP Code:
Please Specify if you ere:
DJnemployed Olheired ❑Homemaker ❑Student OSeltEmployed
Employer Marne:
Spume of Income (dmired or invite/ors)
OordPatForPTYOe Of Ovalness:
Employer Street Address:
City:
State.
ZIP Code:
'If none. Pease submit a photocopy Of slur passport.
AUTHORIZED AGENT/PARTNERITRUSTEErOFFICER INFORMATION
Prefix
OW OltAns. 0 hid Olar. QRev.
Full Legal NUM:
Dale °feints
(1.44-0D.vvrn
Home Address:
Ow PO box or matkfrop)
U.S. Social Security Number:
(SSAti.
City:
ZIP Code;
Please SPICPy 1 yco are.
rignerhotoyed ORetked ❑Homemaker ClEtudent OSalf-Ernployed
ErroplOY•C Nam*:
Scores of income (*soma or uneileSDrecr);
OcouPoliontrYlie Or Business.
Employer Street Address
City:
Stale
ZIP Cede
'If nixie. Please submit a photocopy 01 sour passport.
Please make Ildthlion21000ies if nnenary
3. AFFILIATIONS
OCIviock here r any Pariner/Authonzed Agent, Trustee. Outer. any merrefig of their immediate (entity or any business associate or mess is a senior political
*gun (SPF) Specify NI MOM of the Authortted Agent, the neme or the SPF, dOlil cal tide relationship to the Authonzed Agent and country of ace.
EICheck hare 4 any Pannerfouthonzed Agent. Trustee or °nicer a a ckectot 10% shareholder or policy-making of tut of a publicly traded company $perry the
name of the Authorized Agent. the company ticker awned. name, address. city, and enaleforovince.
OCheck hare if any PannernhuthOnzed Agent. Trustee or Order is licensed or employed ty a registered brckeridealler semillFeS exchange or nwnher of a
securities exchange. We must receive a compliance letter a Ord with this application. Specify ine nag* of the Authorized Agent:
4. INVESTMENTS PERMITTED
The undersigned certify that the entity permits purchases and sales of securities in the following types of accounts as well as all transaction
types indicated below:
DICash
Options:OWrite covered calls, write cash-secured puts
areate spreads
Qi Jdrite uncovered options
[' Purchase options
Page 2 dS
T3A lig/ F 1Ws2
EFTA00283676
May. 8. 2014 3:37PM
Ashford at Spring Lake
No 1296
P. 4
5. ACCOUNT AGREEMENT
In this agreement, 'Account Owner; 'I' and "ny refer to the entity for which this account is established andfor the natural person(s) authorized
to represent and act on behalf of the entity. Under penalties of perjury, I certify (1) that the Social Security Number shown on this form is my
Correct taxpayer identification number, (2) that I am not subject to backup withholding, and (3) that I am a U.S. person (including a resident
alien); provided, however. If tam a nonresident alien as disclosed in this application. I do not certify that I am a U.S. person and r understand
that I must submit a Form W-BSEN. If I have been notified by the IRS that I am subject to backup withholding as a result of dividend or interest
underreporting, I must cross out (2) in this certification. I acknowledge that I have received and read the 'Client Agreement,' evadable at
wwwidamentradecom or by calling BOO-en-3900, that will govern my account. I agree to be bound by the Tkent Agreement' which may be
amended from time to time and which is incorporated by this reference. I release and agree to indemnify and hokl harmless TD Ameritrade.
Inc, its divisions and affiliates thereof (70 Amentrade' from any and all liability and Claims for damages resulting from any action taken
pursuant to this Agreement. By my signature below. I attest that I am of legal age to contract and that the information contaned in this
application is true and correct. The "Client Agreement' applicable to this brokerage account agreement contains predlspute arbitration
clauses. By signing this agreement, the parties agree to be bound by the terms of the agreement, including the arbitration agreement
located In Section 12 of the Client Agreement. All securities, dividends and proceeds yid be held at TO Ameritrade Clearing, Inc. mien
otherwise instructed. I understand that TD Amentrade may obtain a current consumer or credit report to determine my eligibility, or continuing
eligibilty, for credit or for other legitimate business purposes My decision by TD Ameritrade to extend credit may be based on iiturnialion
contained in a consumer or credo report, as well as the policies of TD Amerltrade Clearing, Inc. I understand that TD Ameritrade may relate
information regarding this account, including account delnqueney and voluntary closures, to consumer or credit reporting agencies. Upon
my request, TD Amentrade shall inform me of each consumer or credit reporting agency from which they have obtained and/or reported my
consumer or credit report TO Ameritrade agrees to notify the consumer or credit reporting agencies d I dispute the completeness or accuracy
of the Wormalion furnished by TO Ameritrade. By my signature below, I authorize TO Amentrade to obtain consumer or credit reports for the
name(s) set forth below I understand that non-depose Investments purchased through TD Ameritrade are not insured by the Federal Deposit
Insurance Corporation (FDIC), are not obligations of or guaranteed by any financial intibilion and are subject to investment risk and loss that
may exceed the principal invested. Important Information about procedures for opening a new account: To help the government fight
the funding of terrorism and money laundering activities, federal taw requires all financial Institutions to obtain, verity and record
Information that Identifies each person who opens en atcount. What this means for you: When you open an account, we will ask for
your name, address, date of birth and other information that will allow us to Identify you. We may also utilize a third-party information
provider for verification purposes and/or ask for a copy of your driver's license or other identifying documents. The Internal Revenue
Service does not require your consent to any provision of this docum►nt other than the certification required to avoid backup
withholding. All Authorized Agents, Partners, Trustees and Officers must provide their signatures below.
❑I am the sole officer.
❑Single Member LLC
X
Authorized Agent's Signature:
X
Authcrizeo Agent's Signeha
X
Authorized Agent's Signaturec
Talc
Tile:
Date:
Data:
Tae:
Dale:
if his form is being used to update an authorized agent on an existing TO Ameritrade account, then the rescinding Officer needs to Sign below.
X
Resuming Aueirsted Agent's Stgnalure
Data:
TO Amentrade, Inc., Treater FINRNSIPCINFA and TD Ameritrade Clearing. Inc., member FINRAISIPC. TD Ameritrade is a trademark
jointly owned by TD Ameritrade IP Company, Inc. and The Toronto•Domition Sank. 0 2012 TO Amentrade IF Company, Inc.
All rights reserved. Used with permission.
Page3c13
70,11100 F teft2
EFTA00283677
May. 8. 2014 3:38PM
Ashford at Spring lake
No 1296
P. 5
'U Ameritrade
PO Box 2760 =Omaha, NE 68103.2760
Fax:
Agent Authorization
Limited to Account Inquiry
This form only grants the ability to inquire about account status, transfers, positions or balances. The undersigned hereby authorizes
Authorized Agent (the Triquirme Apert):
Acodsa Number(s):
(whose signature appears below) as the undersigned's agent to inquire about account stakes. transfers, positions and balances for the
underskinecrs account and In the undersigned's name or number on TDAmeritrade's books in accordance with the terms and conditions set
forth in the Standard Account Agreement, and three terms end conditions'otherwise established by TD Ameritrade. If the undersigned is a
fiduciary on the account, then the undersigned hereby slates and affirms that this authority is granted in such fiduciary capacity and withIn the
fektiary powers consistent with the fiduciary duties of said fiduciary. The undersigned hereby agrees to indemnify and held TO Ameritrade
harmless from end to pay promptly on demand any and all losses arising therekom or debit balances due thereon.
This authorization and Indemnity is in addition to (and in no way limits or restricts) any rights which TDArneritrade may have under any Wier
agreement or agreements between the undersigned, the Introducing Broker, and TD Amedtrade.
This authorization and indemnity is a continuing one and steel remain in full force and effect until revoked by the undersigned by a written
notice addressed to the Introducing Broker and delvered to its office. Such revocation shall not affect any liabiity in any way resulting from
transactions initiated prior to receipt by the introducing Broker and the Clearing Broker of written notice of such revocation. This authorization
and indemnity shall inure to the benefit of the Introducing Broker and TI) Ameritrade and of any successor firms irrespective of any change or
changes at any time in the personnel thereof for any cause whatsoever and of the assigns of the Introdming Broker and TD Ameritrade of any
successor M1 nu(s).
This authorization supersedes any prior inquiring authorization the undersigned may have executed with regard to his/her account with the
Introducing Broker and TD Ameritrade.
Original Signature required; electronic signatures andlor fonts ere not authorized.
ACCOUNT OWNER
Printed Name.
)( Account Owner Signalise:
ACCOUNT CO-OWNER (Ii Joan account both winos must sign )
Printed Name.
Dalt;
Full Legal Name
Date of Binh:
fA4M-00-YYYY;
Street Address:
Phone Number:
City
State:
ZIP Code:
Email Address
Employer Name
Occupation:
X
Agent Signet"-
Investment Products: Not FOIL Insured • No Bank Guarantee ' May Loss Value
o Arnow* N , inviter FINRNSIPCM A end TO Amentrade gearing, Mc., MEOW FINRNSIPC. T1) Amentrade 6 a trademark piney owned by TD Amen trade
P Comp ny. Inc.
d The Toronto-Dominion Bars. Ci 2013 TO Arneneade IP Company, Inc. Ill tips reserved. Used Ain DenneSien.
11111111
1111
11111
Page toil
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EFTA00283678