EFTA Document EFTA01392795

ATM/Debit Service You agree that the retention or use of the ATWDebit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service It you have selected to receive Internet Banking Services, you understand that you will be required to enter into a separate Internet Banking Services Agreement with OBTCA 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 that 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 responsibility 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 accounts) and your business relationship with DBTCA. 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), beneticiary(ies), pertner(s), etc. to enable him/her/ them to fulfill any respective tak obligations that may arise for him/her/ them in connection with your business relationship with DBTCA. Please complete and attach soparate W-8 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts anached to this Application and agree to be bound by them. In addition, you agree to notify us immediately of any materiel 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 You understand that this a I alion is sub'ect to acceptance by DMA. Account Holder's Signature Date Joint Account Holder's Signature 2//ths Dale t. r 54, fixt9;," tt; ni Matta 'erlav- brit tOseijS.8,MtgAittt • Ase ‘4.11. -l .e01.9tivN•—••r•-•'^c pin Pv~ rs. mi. 4 %W.Oe -/- ,•••... P a A Ni ♦ i4046144ie j^c Accep re' • 0- JP. (Name t er S AY r. , ewMpken,rst".;',radrair "Ur ' ,art:02.43(4,,s aiwS, • ? frW) N I% .... IN i PC • % it rt. - 0 , .- S. c7n sr. tilieri mg r .. r . j r.,. • - ;WA '3/4-totQW ^tr AV :31. 431 ka-4t. Tr' 4.7 . eVY• •73, rt. .• • 13-AWM.0101 013959 033513 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0098063 SDNY_GM_00244247 EFTA01392795