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Page 14 of 43
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summa
3A. Individual Details (for all parties)
Individual's Name:
Erika Kellerhals -
Date of Birth:
Country of Residence:
Virgin Islands, U.S.
Country of Citizenship:
United States
Address of primary residence:
Has client resided outside of
his/her country of nationality
for 5 years or more?
L.J yes ItZ. No
Profession/Occupation:
Attorney
Tax ID / SSN:
Current Employer:
Kellerhals Ferguson Kroblin PLLC
Position/Title/Rank:
Attorney
Address of employer:
9100 Port of Sale Mall, Ste 15 St. Thomas Virgin Islands, U.S. 00802
Does the person work as senior executive of a DB-recognized regulated entity in the financial
ndustiy? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities O Yes .^..
Is the individual a Politically Exposed Person (PEP)?(if Yes desenbe) N/A
❑Yes
RI NO
To the best of your knowledge, is the individual related to an employee of the DB group?(if
Family or Fnendship, describe) N/A
K Family
0 Friendship
E) None
TO the best of your knowledge, is the individual party to a non-banking relationship with
Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or
services)?(if Yes,deScnbe) N/A
0 Yes
M 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:
Oient Private
Domicile:
Client Place of
Business:
Other Location (specify):
Date:
LI
0
U
U
0
U
r1
0
L.J Wealth Details for this individual are not filled in, because they are the same as for the following person:
38. 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 industry of source of Wealth/Source of Funds?
Summarize Source of Wealth:
0 Business Owner OSalary/Earnings 0 Investment 0 Inheritance/Gifts 0 Other:
Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did settlor accumulate weakh? For inheritance,
how did family accumulate wealth?For business owners, how long in business, how many employees, level of profitability? Indicate type of business, countries
of major activities, important business partners.)
Estimated Annual Income(;):
Estimated amount of investable assets($):
littps://dbforcepb.my.salesforce.com/servlet/servlet.Integration9lid=0IN30000000D9Di&eid=5000e0000 I N... 7/10/2019
CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e)
DB-SDNY-0042682
CONFIDENTIAL
SDNY_GM_00188866
EFTA01356690