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efta-efta01345273DOJ Data Set 10CorrespondenceEFTA Document EFTA01345273
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DOJ Data Set 10
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Page 5 of 19
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summary
3A. Individual Details (for all parties)
Individual's Name:
- 00000486405
Date of Birth.
Country of Residence-
USA
Country of Citizenship.
USA
Address of primary
residence-
Livingston NJ 07039 United States
Has client resided outside
of his/her country of
O
nationality for 5 years or
more?
Yes Y. No
Professon' Occupat ion.
Lawyer
Tax ID .' SSN
Current Employer:
Southern Financial LLC
Pcsmon'Title:Rank
Address of employer:
575 Lexington Avenue, 4th Fl Livingston NY United Slates 10022
Does the person work as senior executive of a DB-recognized regulated entity in
he financial industry? (Not applicable for operating entities)
O yes g6 No
Is the Individual a Poltioally Exposed Person (F£P)?(If Yes, describe)
OYes
®No
To the best of your knowledge, is the individual related to an employee of the DB
group7(if Family or Friendship. describe )
OFamily
O Friendship
None
To the best of your knowledge, is the individual party to a non-banking
relationship with Deutsche Bank (e.g., external legal counsel, dent referral
source, supplier of goods or services)?(if Yes,describe )
OYes
66 No
If applicable, indicate which bank officers have met
the person:
Indicate where and when the client meeting(s) took place:
Bank Officer Name(s)
Bank Office
Client
Prvate
Domicile.
Oient Place
of Business:
Other Location (specify):
Date
El
O
o
O
O
E
O
O Wealth Details for this individual are not filled in. because they are the same as for the following person:
3B. Wealth Details (Only for parties requiring source of wealth description as indicated in Section 2)
Nature of the Individual's Business:
Primary Country of source of wealth/source of Funds?
Primary Mclustry of source of Wealth/Source of
Funds?
Summarize Source of Wealth:
O Business Owner O Salary/Earnings El I treatment i
nneritance,G Its
O Other:
Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did settlor accumulate
wealth? For inheritance, how did family accumulate wealth?For business owners, how long in business, how many employees. level a'
profitability? Indicate type of business, countries of major activities, important business partners.)
https://dbforcepb.my.salesforce.com/servlet/servlet.Integration?lid
IN30000000D9Di&e... 7/30/2018
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0031525
CONFIDENTIAL
SONY GM_00177709
EFTA01345273
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