EFTA Document EFTA01356691

KYC Print Page 16 of 43 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: United States Country of Citizenship: Russian Federation Address of primary residence: Has client resided outside of his/her country of nationality L.J yes ITLI No for 5 years or more? Profession/Occupation: N/A Tax ID / SSN: Current Employer: N/A Position/Title/Ra