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efta-efta01370176DOJ Data Set 10Correspondence

EFTA Document EFTA01370176

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DOJ Data Set 10
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efta-efta01370176
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
PaC. 3 ac41::ynazur.) If Non-US Beneficiary/Non-US Beneficial Owner is an Individual: 1. I hereby certify that for the purposes of taxation I am not a tax resident In any country other than the country/countries indicated above. 2. I confirm that my ownership or other interest in the Entity. if any. is appropriately disclosed In accordance with applicable laws and regulations in the countries in which I am tax resident and may be required to be reflected in my tax filings. 3. I confirm that all Income or capital distributions received (or deemed to be received for tax purposes) by me from the Arrannt(s) have been, and going forward will be, taken into account and included in my relevant tax filings if required by the laws of the country (countries) of my tax residence. If Non-US Beneficiary/Non-US Beneficial Owner is an entity: 1. I hereby certify that for the purposes of taxation the non-US Beneficiary/non-US Beneficial Owner is not a tax resident in any country other than the country/countries Indicated in this self-certification. 2. I confirm that my ownership or other interest in the Entity. if any, is appropriately disclosed in accordance with applicable laws and regulations in the countries in which I am tax resident and may be required to be reflected in my tax filings. 3. I confirm that all income or capital distributions received (or deemed to be received for lax purposes) by me from the Account(s) hay.) been, and will be, taken into account and included in the relevant tax filings if required by the laws of the country (countries) of tax residence. I agree that Deutsche Bank may disclose this Certification and any other information related to It or the Accounts) now or in the future held with Deutsche Bank. to any relevant tax or governmental authorities of the country in which the Account(s) islarehvel be maintained or of any country in which I may be liable to pay taxes. I release Deutsche Bank from any obligations of bank secrecy, confidentiality and/or data protection under any applicable laws which might otherwise preclude the disclosure of such Information. I acknowledge that the data protection laws of such other countries may not afford the information the same protections which it receives in the country in which the Account(s) is/are/will be maintained. I understand that this waiver will remain In force until cancelled and notwithstanding cancellation It cannot be terminated retroactively. I declare that all statements made in this Self-Certification are, to the best of my knowledge and belief..correct And causes the information contained herein to become incorrect a n ircumstances o h am aware of and that kwith a suitably updated complete. I undertake to advise Deutsche Bank promptly of any cha Certification within 30 days of such change in circumstances. Jeffrey Epstein PrIM Name of Signor 04.28.2018 Data (mm-def.lryyY) Copacly Note: II swing on Wharf of an entity, please indicate the capaoly in WhICJI you are signing (tor morn* Trustee. COrPOraleAndriand Director. etch Signature INTERNAL USEONLY: AC:COutit Nurnb0601) 42 2016 Deutsche Bank AG. An name reserved. WM167679 023611 041516 Page A2.2 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0062814 SDNY GM_00208998 EFTA01370176

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