EFTA Document EFTA01345234

KYC Print Page 15 of 34 One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summa 3A. Individual Details (for all parties) Individual's Name: - Date of Birth: Country of Residence: USA Country of Citizenship: USA Address of primary residence: 49 Zorro Ranch Rd Stanley 87056 United States Has client resided outside of his/her O country of nationality for 5 years or more? Yes iA No Profession/Occupation: Manager Tax ID / SSN: Current Employ