EFTA Document EFTA01345235

KYC Print Page 17 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: Harry Beller Date of Birth: Country of Residence: USA Country of Citizenship: USA Address of primary residence: Has client resided outside of his/her country of nationality for O yes iA No 5 years or more? Profession/Occupation: Accountant Tax ID / SSN: Current Employer: HBRK Associates, Inc Positio