EFTA Document EFTA01480377

0 CHASE JPMorgan Chase Bank PERSONAL SIGNATURE CARD AM) APPLICATION BRANCH COPY Account Title (Accounts with multiple owners are John, parable to either owner or the survivor.) Account I Account Type Account An, DIVIDUAL SSI/TIN Date Opened 02/19/M4 Opened By PHILLIP WAITERS Deposit And $0.01 Primary Customer Information Home Ph (0301000-0000 Birth DateafTEN CHASE EXTRA SAVINGS ACCOUNT Malden N This Account IS Not Transferable Please activate Check Coverage for the account listed above. Uwe authorize you to integrate and use as the Protecting Account(s)' the account(s) identified above on this application. Uwe agree to the terms and conditions as contained in the Deposit Account Agreement and Disclosures. !Ave agree that I/we have reviewed the information contained in this Personal Signature Card and Application and find it accurate on this date. In the payment of hinds and in the transaction of all other business relative to this account. lAve agree that you are authorized to rely upon the signature(s) written below and on the -_reverse.side._Uvre.have.received.and.agree.to_the.terms_and_conditons of the Deposit Account Agreement ano Disclosures currently in Out and as may be amended fur the type of Ut-ourit andservicos Uwe seicacd— above. If I/we do not have a Chase Banking Card, Uwe will be issued one/two and all eligible accounts will be linked to it/them. These linked accounts, whether singly or jointly owned, can be accessed by the Chase Banking Cud or by telephone. During the review of my/our application, you may obtain a consumer report on me/us and if the appliCatlon Is approved, you may at any time in the future obtain additional consumer reports to review my/our account. Wm have the right to ask for the name and address of the mer reporting agency which gave the consumer report. Joint Applicant Signature 9 Certification By signing below. I certify under penalties of perjury that (1) The number shown on this form Is my correct taxpayer identification number; and (2)1 am not subject to backup withholding because (a) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (b) the IRS has notified me that I am no longer subject to backup withholding; and, (3) I am a U.S. person (including a U.S. resident alien). [ I Check here if you are subject to backup withholding for failure to report interest or dividends. Check here if you are not a U.S person (r a U S. resident aren), and complete the appropriate Form Joint Applicant Signature X malting or o ec s eme e authorize you not to return paid cheats with my/our account statements. If Uwe selected the Check imaging option, Mu agree to receive Images (front only) of my/our paid checks. I/We agree that the account statement will contain information about each check paid, including check number, dollar amount and date paid, thereby enabling a proper reconciliation of the account. You will not retain original checks. Joint Applicant Signature X Check here if there ere edditlonal signers on the reverse side of the BRANCH COPY. THE ABOVE iNFOAKWIllilti AND (P40.) ,SIGNATURC(S)(FRDEARY AND IF APPUCABLI)WER2 VERIRE0 SY: Peen Pan t -'7f: I/ if LIPII-41.0.4 triOrts Dept NoRk. Ma.: '7 Yi BRANCH COPY-Raterscard ontnen tot one frier aft account doses Than and to Foam for 1106IFFM4 nation cillbssirs • Confidential Treatment Requested by JPMorgan Chase CONFIDENTIAL JPM-SDNY-00002517 SDNY_GM_00271715 EFTA01480377