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efta-efta01392789DOJ Data Set 10Correspondence

EFTA Document EFTA01392789

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DOJ Data Set 10
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efta-efta01392789
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service If you have selected to receive Internet Banking Services, you understand that you will be required to enter into a separate Internet Bonking Services Agreement wit° DBTCA before you can access the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below, you acknowledge receipt of DBTCA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You confirm chat it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to you in any relevant jurisdictions that may arise in connection with assets, income or transactions in your account(s) and your business relationship with OBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibirgy to fulfill any tax obligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your account(s) and your business relationship with OBTCA. Furthermore, you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s). settlor(s), beneficiarylies), partner(s), etc. to enable him/het/ them to fulfill any respective tax obligations that may arise for him/her/ them in connection with your business relationship with DBTCA. Please complete and attach separate W-8 or W9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to this Application and agree to be bound by them. In addition, you agree to notify us immediately of any material change to the information provided by you on this Application. You represent and warrant that all of the information provided by you on this Application is accurate. The Terms and Conditions for Deposit Accounts are subject to change. Acceptance Y understand that this arm Account Nocer's Signature subject to a mance by DBTCA. Joint Account Holder's Signature rttc.57 east Rey Wti;•>. alert.t Title: Pp. .0,04;p5 .r.• tcitar 7.7fel/.3 Date Dale itWeartealtalaralitiMattatagriL s OetaSle-Wi. r hattal•.64.• AccoPted•W oPt'agncid tr "Ipgpigtar" her ikeesi x.behT,8 1-ttr nIzr. • -Aa, a' c:... Wil1/44 ....AC' 47.7 " IS " 4 4% 4' i.. . d.!: W , * t: ) .41 4.02 S T ea (01.4 " :30i4jetV 11 /AC S iViVateliC te4. ., ; TK Att el t i. ea WVC'i A riird i.74. 4,:f:dinee§r 6it .. "*Wat.11:n^ aarn6NI?" "ifterajaliglyWa3/44100.44SVA$4,ASSidraRia. :WA i•Trilegit;;fre, ;4 1:7;.: 'iW A LIV4 I 41Agttl 'VtV 31 - 4 , 1,..iV 11V;VI>4.?• ' . ". •""iV " tc7..:1:≥Nr i ntk .l..a% % 'xo er ialtit SP Vell1/2V0, 1.1 1: ir V. ..., .). aDate b sW,i, sr- .2" r; . ,Agref,)-' /1.tftr'll; iSt " ,.4e,V 7 •ie 4-.. ..ti. °.. )...,:re :it, !kstlie.C•itv.i..., C_.,,krarcier,irir. •✓-4; 5.?.s".!;_-,2 •-mir•-”rier;i ' tI.V.8iitlgit• wivrt744:-.4. ,a-a .ra. . Sat,. titra llittlegjente:Ner , 4. - 4 04.• nirr Scl .1,..,.. ....It; -p Aagla 04130tinretr t*X3/41144 is rre In` TT 13-AWFA-0101 013959.037513 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0098057 SDNY_GM_00244241 EFTA01392789

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