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efta-efta01345273DOJ Data Set 10Correspondence

EFTA Document EFTA01345273

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DOJ Data Set 10
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efta-efta01345273
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EFTA Disclosure
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KYC Print 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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