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sd-10-EFTA01355813Dept. of JusticeOtherEFTA Document EFTA01355813
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Dept. of Justice
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sd-10-EFTA01355813
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Summary
BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (I) CLIENT HAS RECEIVED, READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION: AND (21 THE INFORMATION CONTAINED IN THIS ACCOUNT APPLICATION IS ACCURATE. CLIENT ACKNOWLEDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPUTE ANIMATION CLAUSE AT SECTION III. PAGE 5, AND CLIENT AGREES TO ITS TERMS ALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL). L INITIAL HERE: THE INTERN
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Extracted Text (OCR)
EFTA DisclosureText extracted via OCR from the original document. May contain errors from the scanning process.
BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (I) CLIENT HAS RECEIVED, READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION: AND (21 THE INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS ACCURATE.
CLIENT ACKNOWLEDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPUTE ANIMATION CLAUSE AT SECTION III. PAGE 5, AND CLIENT
AGREES TO ITS TERMS ALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL).
L
INITIAL HERE:
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE CUENT'S CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP WITHHOLDING, AND. IF APPLICABLE. THE CERTIRCATION REQUIRED TO EsrAsusx CLIENTS STATUS AS A NON-U.S.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Information for ER ISA employee benefit plan clients: U.S. DePertmerit of Labor regulatIOns reouke DBSI to disclose to a resoonsible plan fiduciary
certain information In connection with the services that DBSI provides to a plan, to assist the fiduciary in evaluating the reasonableness of DBSI's services and
rated compensation. The disclosure is available mane, at httpliwww.pwm.db.comramericasrenierisa_disdosure_pcs.html. By signing below, you acknowledge
that you are a fiduciary responsible for the procurement of DBSI's services to the plan. you have read the disclosure and you understand the disclosure.
Individual or point account (IF THIS IS A JOINT ACCOUNT. ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to futile any taxobligations and any other regulatory reporting duties applicable in any relevant jurisdictions that
may arise In connection with assets, income or transactions in Client's account(s) and business relationship with DB51.
CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVNORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
OTenants in common: Or
CICommunity Pro
ifor mauler couples in canal
, each spouse retains 50% interest In the community property upon death of the first spouse).
Signature
Date 7.-a 4-f
Print Name _Tarsi
\ GeV
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Sgnattire
Print Name
Date
SSN/EIN
Corporation partnership, trust or other entity:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
diem acknowledges having solo responsibility to fulfill any tax obligation:, and any other regulatory reporting duties applicable lo in any relevant jurisdictions
that may arise in connection with assets. income or transactions in Client's acooungs) and business ratkinship with DBSI. Furthennoro. Client confirms that the
necessary Information (to the best of Client's knowledge and capabilities) is made available no leas than annually to the relevant beneficial owner's). settIoris).
benehciary(ies). partner(s). etc. to enable such pawls) to fulfill any respective tax obligations that may arise for such person's) In connection with Client's
business relationship with DBSI.
Name a Entity Southern Financial LLC
Signature of Officer. Partner. Trustee. Authonred Pa
Print Nemo/TaleJeffrey Epstein
Employer ID No. 66479'9192
).----
Date 7 —sci—n
Signature of Officer. Partner. Trustee. Authorized Party
Date
▪ nt Name/Title
Signature of Officer, Partner. Trustee, Authorized Party
Date
Print Name/ isle
13.AWM4198
012145032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0041094
CONFIDENTIAL
SDNY_GM_00187278
EFTA01355813
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