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efta-efta01356044DOJ Data Set 10Correspondence

EFTA Document EFTA01356044

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DOJ Data Set 10
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efta-efta01356044
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EFTA Disclosure
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KYC flint Page 10 of 22 Onesheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3k Individual Details or all parties) Individual's Name: Erika Kellerhals-- Date of Birth. Country of Residence: USA Country of Citizens! o USA Address of primary residence: Profession/Occupation: Atto-ey Tax D SS4 Current Employer: Kellerhals Ferguson )(goblin PLLC Position/Title/Rank: Address of employer: 9100 Port of Sale Mall. Ste 15 St. Thomas VI United States 00802 Is the individual a Politically Exposed Person (PEP)flif Yes, describe) OYes w ,..4 No To the best of your knowledge, is the individual related to an employee of the DB group?(if Family or Friendship, describe ) OFamily O Friendship !1 .Noee To the best of your knowledge, is the individual party toe non-banking relationship with Deutsche Bank (e.g., external legal counsel. client referral source, supplier of goods or servIces)7(if Yes,describe ) K Yes RI 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 Private Domicile: Client Place of Business: Other Location (specify) Date O O O O O O O O O • Wealth Details for this Individual are not filled in, because they are the same as for the following person: 36. Wealth Details (Only for parties requiting source of wealth description as indicated in Section 2) Nature of the Individual's Business: Summarize Source of Wealth: O Busness Owner O SalaryiEarnings OInvestment O Inhentance/Offs Liother 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 o' profitability? Indicate type of business, countries of m jor activities. important business partners.) Estimated Annual Income (E: Estimated amour: of nves:aot assets(S) Estimated Net Worth($)' Amount of assets planned to invest with PWW(S) Other Known Financial Institutions: https://dbforcepb.my .salesforce.com/servlet/servl et. Integration?1 idr.:11N30000000D9Di&e... 1/11/2018 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0041462 CONFIDENTIAL SDNY GM 00187646 EFTA01356044

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