EFTA Document EFTA01355843

Structured Products Agreement and Approval. Form Please Complete All Sections Account Nut Mgt Account 1.1001.. NLIG. - onctoli Account Type ettungttog Juan Toot Pang tering Tac tmy...I,.t4klc. Canunatnt Coo notation GLIM' uthss;it NOTE: IRA and SALSA accounts are prohibited horn purchasing Structured Products. Account and Owner orMatit341: Provide 40(0061341 illiCHMattOM for ciAll benaiicial account owner (-aient"). If more than one owom enisrs. tka Slav:hued Ploducts Agreement and Approval Suppkrocntary Form io this Agreement maybe required. 5 C3 VtIvAN)c1PIL 0. FoS: Allah lam Name nt locnodua Puska, ot E)4DC Kos -se--c-pQr=1 G s- \-6 i 3,3 61 c:' ea) Fic) G-WW)CeV_ 133 , s—r —ric)(31AAS US Vt9. si\-\ tci-MI•VDS nivu tt Seal to )40viiteant - 141h4ODIYUYY 114,.. r.; Addan -RS P.i&AC.-9, Pt al ErnIMann• SGL$ Ty00 at litro tutu. Patine -filNiAMat)L i0Ccivgic_s owevet. moitt(S) C4 tnnontiptovne than atte0,1( (Awn!: tm alttl n4 trot tJ PAIMC*4444altrOt the acCOtu sBniceTir; DARS1-.N) twD11(e) Client(s) Financial Information Approx]rram Aggregate Annual Income of Account Owner(s) kom All Sources Less than $50,000 $50,000 - $99,999 S100.000 - 5249.999 $250,000 -S499,999 S500,000- S999.998 f.1,000,000 - $2.499.999 J2.500.000 - $4,999,999 /.5.LX-0.000 and 09 ef Other (speciiy): /VW' 'WM IWO Olio!? anion/ Sources of Income (Approximate) Salary/Bonus 96 41Unant, 01 0c0001:011VI nnaneLi 141011,.! Aggro:ant-a Net Worth Less than 550,000 550.000 - S99.999 5100,000 - S249.999 $250.000 - $499.999 $500,000- 5999.999 $1.000,000 - S2.499,999 2.500.0410 999 APRIV:imate liquid Nat Worth Excluding Principal Resklence Less than 550,000 550,000 - 599.999 5100.000 - S249,999 5250.000 - 8499.999 5500.000 - $999.999 51,000.000 - 52 499.999 S2.500,000 - S4.999.993 [ S5,000,000 and mei CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0041129 CONFIDENTIAL SDNY_GM_00187313 EFTA01355843