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efta-efta01386247DOJ Data Set 10CorrespondenceEFTA Document EFTA01386247
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AGP LP 519 Alpha Group Capital Paul Barrett
APPENDIX G
AML Requirements
You (the "The New Limited Partner") must complete this supplement (the "Anti-Money Laundering
Supplement") in order to become a New Limited Partner of the Partnership. Your subscription agreement
will not be deemed complete, and you will not be deemed a New Limited Partner of the Partnership,
regardless of whether you have already wired funds, until all of the required documentation listed below is
received by the Administrator.
I.
PAYMENT INFORMATION
(a)
Name of New Limited Partner (no initials):
Address, including Apartment Number (no PO Boxes):
Telephone Number:
Occupation of Individual New Limited Partner or Description of Business of Entity
New Limited Partner:
Nationality / Country of Organization of New Limited Partner:
Taxpayer Identification Number (Employer Identification Number for U.S. entity;
Social Security Number for U.S. individual; or non-U.S. equivalent and country of
issuance):
(b)
Name of the bank from which your payment to the Partnership is being wired (the
'Wring Bank"):
Bank Account Number:
ABA/Fed Routing No. or Swift Address:
Bank Address:
Bank Phone Number:
Name of Account:
You must wire the payment from an account in your name.
You must provide a letter of reference from the Wiring Bank or a bank or
broker-dealer located in a FATF-member country. (A sample letter of reference
is attached hereto as Annex F.)
(c)
Were the funds for this investment generated by your occupation or the business of
the entity investing in the Partnership?
Please provide a statement explaining the source of the funds being invested on
Annex A below.
(d)
Is the Wiring Bank located in a FATF Country?
(e)
Are you a customer of the Wiring Bank?
YES
NO
K
K
K
K
K
K
Appendix G-1
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0087858
CONFIDENTIAL
SDNY_GM_00234042
EFTA01386247
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