Case File
efta-efta01125044DOJ Data Set 9OtherFIRST PRIVATE
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DOJ Data Set 9
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efta-efta01125044
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11
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0
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FIRST PRIVATE
EQUITY GROUP
PETER LEVINE
SENIOR TRADING ADVISOR
AMERICAN INTERNATIONAL BUILDING
70 PINE STREET
NEW YORK, NY 10005
TEL
FAX:
HTTP://WWW.FPEGWEB.COM
EFTA01125044
REilT PRIVATE
EQUITY GROUP
Account Opening Kit
American International Building
70 Pine St. New York. NY, 10005
Tel: (+1)
Fax: (+1)
Guidance Notes
Please write clearly in the white spaces with
Capital letters or ticks the boxes.
Please sign and date as required and return to:
Fax: (+1)
Contents
This Account Opening Kit includes all relevant documentation to formally commence your investment. To Open
the Account you will need to complete each of the following:
1. Account Opening Form: So that we can offer our clients the best available advice, we ask that you complete
your personal details and return the form signed and dated.
2. Terms of Agreement: A detailed review of our operating processes which will outline the way we can work
effectively on your behalf.
3. Confidentiality Agreement: As a client of the company. you will have access to company information
which may be sensitive. To preserve the integrity of this information and to ensure that this information is not
used for external economic gain, First Private Equity Group, requires signing of this Confidentiality Agreement.
4. W8-BEN Form: To register foreign status and to ensure you are exempt from US taxes and fees associated
with this investment account. This document will be included as a separate attachment.
You will also receive:
5. Funding Instructions: This is how you will fund your account opening. Section 4 of this Account Opening
Kit details the relevant instructions for international bank-to-bank transfer. Use this document to ensure correct
remittance details. To settle the account. our oavment details are provided and should be followed exactly as
stated to avoid any delays in the funds clearino with our bankers. The oavment is to be made by IBAN or
SWIFT teleoraohic transfer within one business day. Please provide First Private Equity Group with a copy of
the transfer receipt pending clearance.
Once received, a receipt will be sent to you from First Private Equity Group. This receipt will confirm the
details, amount paid, and your now account number.
Type of Accounts: There are three account levels available at First Private Equity Group.
Silver: Min. $100,000.00 deposit. Gold: Min. 5250,000.00 deposit. Platinum: $1,000,000.00 deposit.
Please circle the account type that you are applying for.
EFTA01125045
1
Account Opening Form — (personal details)
Account Owner
Title (please tick)
Mr
Mrs Miss Ms
Other (please specify)
Your Last Name
Your First Names
Nt(cbtal
Mailing Address
City
ea10
State
6401CLOM1)
Zip
02 -6/(Q
Country
Nors#WAtti
Daytime Telephone Number
Evening Telephone Number
Email Address
Date of Birth (MM-DD-YYYY)
Place of Birth
13S-RA)M
Marital Status
IttistecOP
Number of Dependants
Mothers Maiden Name
Tag' LA, (A4Ar5ck) fiANeice1J
Second Account Holder (if applicable)
Title (please tick)
Mr Mrs
Miss Ms
Your Last Name
ostopaas4
Your First Names
1 —OKI
Mailing Address
Other (please specify)
City
Sto
State
(A) oguutost)
Zip
Country
Daytime Telephone Number
Evening Telephone Number
Email Address
Date of Birth (MM-DD-YYYY)
Place of Birth
09I0
Marital Status
MAePC,
Number of Dependants
Mothers Maiden N
e r
T7e
6, 9 lor CAPPCW4f) RCYCKPM1/-
2
EFTA01125046
Account Owner
Employment Status (please tick)
Employed
Homemaker
Student
Retired
Other (please specify)
Start Date With Current Employer (MM-DD-YYYY)
0
e
(
9 9 6
)( Self Employed
Employer's Name
ARICtiarree-40Pai LtU£ fear/VAS
Employer's Address
r
tstoer dc\-“,c
02-n- CiSt--0
City
os fr e i
State
NOISAA.ber
Zip
Country
NoietUistit'
Employer's Telephone Number
Evening Telephone Number
Occupation Type
ARCIAI
Industry Type
Title / Position
'wan iruc-
Rrevlous Employers
Second Account Holder (if applicable)
Employment Status (please tick)
Employed
>e Self Employed
Homemaker
Student
Retired
Other (please specify)
Start Date With Current Employer (MM-DD-YYYY)
(2
0
!
le 0
Employer's Name
Fgo6N cr. ACN to tiC
Employer's Address
PeA6NEK MONACErer
ZAttLIKAraeic
gctfAFT3 PC. Z.
0243- etS(O
City
OSL-1D
State
Zip
N)01CtotAcr
OZeR—
Country
Employer's Telephone Number
tvening ierepnone Number
Qccupation Type
CHCV NIA arm orN ugsozi
dustry Type
Ksz,r,r
Title / Position
3
ye-ito mASIS(
Previous Employers
EFTA01125047
1
Account Opening Form - (financial profile)
Total Annual Income (please tick)
€ 0 - € 100.000
E 100.000 - E 250.000 X E 250,000 - E 500,000
E 500,000 - E1000.000
E 1000.000 +
Total Household Income
€ 0 - € 100,000
E 100,000 • E 250,000
E 250,000 - € 500.000
E 500.000 - €1000,000
E 1000,000 +
Total Net Worth
E 0 -
100,000
E 100.000 - 250,0001
E 250,000 - 500.000
E 500,000 - €1000.000
€ 1000,000 +
Are you a director, executive officer, 10% shareholder or someone who has the ability to control corporate
action of a public company? (please tick)
Yes >e
No
1
Account Opening Form — (account profile)
Account Objectives (please tick)
Income
y Growth
Risk Tolerance (please tick)
Conservative ) 1/4 Moderate
Total Return
Aggressive
4
EFTA01125048
2
Terms of Agreement
Client Trading Agreement
In consideration of First Private Equity Group (FPEG) accepting the account (the 'Account").
the Client (the "Client") agrees:
1. That this Agreement is in reseed to all Security transactions in the Account of the Client. This
Agreement is in respect of all transactions in the Account of the Client, including accounts previously
opened. opened in the future or from time to time closed and then reopened or renumbered; that the
word "Securities" shall include all Securities generally so-called and in particular shall include equities.
bonds, debentures, notes, options. warrants, rights. "When Issued" Securities of all kinds and chooses in
action of every kind, and all property customarily dealt in by brokers.
2. That every transaction is subject to the constitution, by-laws, rules, regulations and customs of the
Exchange upon which the transaction is executed, and to the customs and regulations (now or hereafter
in effect), of the applicable Clearing Corporations including, without limitation, position limits and
exercise limits, and if not executed upon any exchange to the by-laws, rules. and regulations and
customs of any market association of brokers or dealers made applicable thereto by any law or
agreement.
3. That the Client shall pay any and all commissions to FPEG in respect of all purchases and sales of
Securities in the Client account.
4. That FPEG operates on a flat one percent (1) commission on both entry and exit trades. Entrance
commission will be added to the total amount payable. Receipt of funds that is short of trade value,
inclusive of commission, will be deemed to have paid commission but left the remaining portion of the
trade unpaid. lithe client executes a sell order through a third party. the exit commission agreed to be
paid to FPEG will be deemed to be standing and indebted accordingly.
5. That FPEG shall not be responsible for any delays in bringing the Client's order to market, including
delays caused by failure of communication services or equipment or by excess volume of trading.
FPEG shall not be responsible for the accuracy of any quotation or market information given to the
Client. FPEG shall not be responsible for any loss or damage incurred as a result of a trade made
upon the advice of any employee of FPEG or as a result of the cancellation or change of an existing
order not reaching the trading point prior to execution of the order to be cancelled or changed.
6. That as part of FPEG's service directive, the account managers of FPEG undertakes to keep the
Client informed throughout the process of the trade, keeping the Client abreast of major market
movements, and issuing appropriate recommendations when to sell. Ultimate responsibility for the
decision to sell is borne by the Client and FPEG will make available specified public and private
resources to assist Client preparedness.
7. That for said securities that return a dividend on investment, the company will seek returns and
destination of that dividend by remittance to an account of the clients' choice/approval.
8. That upon encashment of any security or cancellation of the clients' account the client at his/her request
may have funds directed to an account of choice subject to the client providing all necessary references
to execute the request.
9. That FPEG, its and their respective directors, officers or employees may at any time or from time to
time have a position in any or all Securities being traded on behalf of FPEG's Client, and that
FPEG will, if trading in the same Securities, at the same time as the Client, undertake to accord the
Client's order priority in accordance with existing rules and regulations of the exchange or market where
the order is being executed. .
10. The Client acknowledges and consents that FPEG is required to report any position that is in violation
to the regulatory authorities.
11. That every transaction indicated or referred to by FPEG in any notice, statement, confirmation or
other communication, and every statement of account shall be deemed and treated as authorized and
correct and as ratified and confirmed by the Client unless FPEG shall actually receive at FPEG's
Head Office written notice to the contrary within forty-five (45) days from the time such notice, statement,
confirmation or other communication was sent by FPEG to the Client by mail or through any other
method of delivery. Until otherwise instructed in writing, FPEG will send all such documents to the
Client at the permanent address of the Client.
5
EFTA01125049
2
Terms of Agreement
12. To undertake to advise FPEG in writing addressed to the Head Office of FPEG in New York City
to the attention of the Client Services Manager, of any and all changes to the information appearing on
any of the Client's application forms. All written notices and communications sent by FPEG to the
Client will be deemed to have been received if sent by mail or any means of prepaid. transmitted or
recorded communication or if delivered to the Client, at the permanent address of the Client or as
otherwise directed herein.
13. That this Agreement shall ensure to the benefit of FPEG and be binding on them and their successors
and assigns and on the Client's successors, executors. administrators. assigns, and legal
representatives and shall be interpreted according to the Laws of the country of investment.
14. That all transactions will be quoted in US Dollars.
15. Trades in currencies other than the currency of the account in which the trade is to settle require
currency conversion. We act as principal when converting currency for such transactions at rates
established or determined by us. This will be taken directly from current market exchange rates. We may
earn revenue on the spread between the bid and offer rates for the currency and the rate at which the
rate is offset in the market. Any currency conversions will take place on the trade date unless otherwise
agreed.
16. That this agreement supersedes all previous agreements between me and First Private Equity Group.
17. That the signature(s) appearing on this form isfare true and official signature(s) of the aforementioned
account and may be used for verification of the said account at all times and for all purposes. The
personal information supplied to First Private Equity Group is deemed truthful and accurate.
6
EFTA01125050
2
Terms of Agreement
Privacy Policy
Al FPEG, we understand that the privacy and security of your personal and account information are important
to you. FPEG maintains confidentiality standards that are designed to protect your personal information.
When you browse the public portions of the FPEG website
information cannot be retrieved from FPEG 's systems.
your account and/or personal
FPEG employee access to customer information is limited to staff that require the relevant information to
properly service your account. Our employees are continuously educated on the importance of maintaining the
confidentiality of customer information. When we collect information about you, we will explain how we intend to
use it. We limit the information collected to what we need for those purposes, and use it only for those purposes.
We will give you access to the information we retain about you, and make every reasonable effort to keep your
information accurate and up-to-date. You can help by keeping us informed of any changes, such as a new
address or telephone number. If you find any errors in our information about you, let us know and, if incorrect,
we will correct them. If you require information, simply contact us with specific details of your query. We will
advise you in advance if a charge will be required for conducting the search, and we will respond to your request
within 7 days.
Any personal and account data maintained by FPEG is done to fulfill our legal and regulatory requirements
and to provide you with the products and services you request. Save for these exceptions, FPEG will not
share, sell or distribute your personal or account information to any outside source.
Usually, you can refuse your consent to share information. or withdraw it at any time. by contacting us in writing.
We will explain your options and any consequences of refusing or withdrawing your consent. and record your
choices. If you donl want us to share information with your referring financial institution, you can tell us any time.
Communications with FPEG are secure. FPEG utilizes state-of-the-art Internet security. We will release
your information when required Of permitted by law. We must give information in response to a valid demand.
search warrant or other legally valid enquiry or order. We may also disclose information to an investigative body
in the case of a breach of agreement or contravention of law - this helps prevent fraud, money laundering or
other criminal activity.
For regulatory purposes, self regulatory organizations require access to personal information of current and
former clients, employees, agents, directors, officers and others that has been collected or used by FPEG.
SROs collect, use or disclose such personal information obtained from FPEG for regulatory purposes.
including:
•
Surveillance of trading-related activity;
•
Sales, financial compliance, trade desk review and other regulatory audits;
•
Investigation of potential regulatory and statutory violations:
•
Regulatory databases;
•
Enforcement or disciplinary proceedings;
•
Reporting to securities regulators; and
•
Information-sharing with securities regulatory authorities, regulated marketplaces, other SROs and law
enforcement agencies in any jurisdiction in connection with any of the foregoing.
7
EFTA01125051
3
Confidentiality Agreement
This Confidentiality Agreement entered into by
Nee/At AtEcAN
-Met (#P ELCA-
"The Client;
and
First Private Equity Group "The Company'.
This
73rr day of MA!
.2012.
WHEREAS. The Company is prepared to make its Confidential Information available for review by persons who
may be interested in purchasing securities. but desires to protect its Confidential Information.
WHEREAS. The Client is considering purchase of securities and may receive such Confidential Information in
connection with a due diligence review of the prospective security.
IT IS AGREED:
1. The term 'Confidential Information' shall include any information that derives independent economic value
from the fact it is not commonly known by the public. This also includes all written and verbal communications
by Company to the Investor, including the fact the Company is seeking to complete any business transaction.
2. Investor acknowledges that this Confidential Information is of value to the Company by providing it with a
competitive advantage and is not intended for general dissemination.
3. Upon receipt of any Confidential Information. Investor agrees to prevent its disclosure to any third party,
unless expressly authorized by Company.
4. Any violation of Paragraph 3. shall be considered a material breach of this Agreement, and Investor agrees
the Company will be entitled to all available civil remedies, including attorney fees and court costs.
5. Investor agrees that the provision of Confidential Information by Company constitutes adequate legal
consideration for a valid and binding Agreement.
IN WITNESS WHEREOF.:
toes CesPreai
61-1,FSEV
CLIENT NAME
CLIENT ADDRESS
8
EFTA01125052
4
Banking Instructions
Beneficiary Banking Details
Funding instructions are included in a
separate sheet attached herein.
REFERENCE INSTRUCTIONS:
I. Complete the banking details in accordance with above.
2. Include the invoice number in the memo section of the transfer form.
3. Check - 'Remitter pays all banking fees'.
4. Fax a copy of this invoice and a copy of the transfer receipt to:
FAX: +1
5. Confirmation of funds receipt will be forwarded to you immediately when
processed.
9
EFTA01125053
Form W-8BEN
(Rev. December 200(1
Oupannitni of the beastay
Internal Rerenue Same
Instead. use Form:
Do not toe this teem for:
• A U.S. citizen or other U.S. person, including a resident alien individual
W-9
• A person claiming an exemption from U.S. withholding on income effectively connected with the conduct
of a trade or business in the United States. .
. . . .
.
.
. .
.
/43ECI
• A foreign partnership. a foreign simple trust. or a foreign grantor bust (see rnsuuctions for exceptions)
W-BECI or W-RIMY
• A foreign government. international organization. foreign central bank of issue. foreign lax-exempt organization.
foreign private foundation, or government of a U.S. possession that received effectively connected income or that is
claiming the applicabilty of sectioMs) 1150. 501(c). 892. 895. or 1443(b) (see instructions) . .
•
.
.
.
.
tftElEa or W.OEXP
Note: These entities should use form 141-8BEN if they are claming treaty benehts or are providing the form only to
elan they are a faeign person exempt hem backup withholding.
• A person acting as an intemedery
W.81MY
Now: See instructions for additional exceptions.
Certificate of Foreign Status of Beneficial Owner
for United States Tax Withholding
e Section references are to the Internal Revenue Code. e See separate Instructions.
e Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545.1821
Part I
Name or Incleadual or of nation al Is the beneficial owner
NtIACIAt
eavvelCKI
2
Country of incorpxation or 0rgarezatIcii
0
3
Type of beneficial owner:
eider/dual
0
Corporation
0
Disregarded entity
1. 1/43Panii:i sit4j
up k
t
Simple trust
CI Grano" tint
K convaxiium
0
(state
0
Gcrennmetill
0
intonational agars:atm
0
Cartel bank Cl issue
K
Tax.exempl onpanateron 0
Private larritialton
4
Permanent residence address (sheet ant. or suite no or rural mute) Do not use a P O box or
-careof address.
it Qrtown. state or province. Include postal code where appropriate.
Cif)
Country (do MX abbreviate)
1JentivAt-
S
Mailing address (If different from above)
City or town. stale or province. Include postal code where appropriate
Country (do not abbreviate)
6
U.S. taxpayer identification number. il required (see instructions)
K SSN or ITN 0
ON
7
Foreign tax iiientilying number. if any (optional)
8
Reference %mere%) (see instructions)
Identification of Beneficial Owner (See instructions.)
Part II
Claim of Tax Treaty Benefits (if applicable)
9
1 certify that (check all that apply): it
a
The beneficial owner is a resident of N
wahn the meaning of the income tax treaty between the United States and that country.
b U II required. the U.S. taxpayer identification number is stated on line 6 (see instructions).
c 0
The beneficial owner is not an individual derives the item (or items) of income for which the treaty benefits are claimed. and. II
applicable. meets the requirements of the treaty provision dealing with limitation on benefits (see instructions).
d 0
The beneficial owner is not an individual_ is claiming treaty benefits for dividends received from a foreign corporation or interest from a
U.S. trade or business of a foreign commotion. and meets qualified resident status (see instructions).
• 0
The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707th). and will file
Form 8833 it the amount subject to withholdmg received dung a calendar year exceeds, in the aggregate. $500.000.
10
Special rates and conditions (II applicable—see instructions): The beneficial meter is claming the provisions of Article
of fits
treaty identified on line ga above to claim a
% rate of Mlhholding on (specify type of incom0
Explain the reasons the beneficial owner meets the terms of the treaty article:
Part II
11 O I have provided or wiN provide a statement that identifies those notional principal contracts from which the income is not effecezely
Connected with the conduct of a trade or business in the United States. I agree to update this statement as required.
IEMI
Certification
Under penalties or penury. I dean that I have examined the mformation on this ram and to the best d my knOwledge art belief t is true. correct. and complete. I
runner certify user penalties of perjury that
• I am the beneficial ownertr an authorized to sign fa the beneficial owner) or all the income to which this form relates.
• The beneficialowner is not n U.S. person.
• The income to vetch this form relates is not ellecinenconnected wati ate conduct ol a bade a business ti the United Slates or is effectively connected but rs
not subject tout under an Won* lax treaty. and
• For btokel transactions a boner exchanges. the benercioi cvmet e an exempt Iceman person as deleted. the eyelet/on>
Furthermore. I ailhcni0 the tom to be provided to any withhoiding agent that has control, receipt or onto* of to 'name d whch I an the beneficial owner or
any rwthrolding sort they cyg timbale
Ake y ymyr. ol the income ce wrath I am the teneetiat Owner
Notional Principal Contracts
73
Sign Here
•-202 ,-
Signature of benefice' ow
or rithvidual aurnnd to sign kg beneficial owner)
Dale IMM.00•WYY/
CaPaclY m which acting
For Paperwork Reduction Act Notice,
separate inStruCtIonS.
Cat. No 250472
Form W-8BEN (Rev. 124003
EFTA01125054
Technical Artifacts (10)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Domain
www.fpegweb.comPhone
1545.1821SWIFT/BIC
RCYCKPM1URL
HTTP://WWW.FPEGWEB.COMWire Ref
REFERENCEWire Ref
ReferenceWire Ref
referencesWire Ref
referringWire Ref
transfer receiptWire Ref
transfer withinForum Discussions
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