EFTA Document EFTA01357586

Banking Account Information Banking Name: Banking Address: City: State: Zip/Postal Code: Banking Phone Number: Banking Email Address. Accountant Name. Accountant Address: City: State: Zip/Postal Code: Accountant Phone Number Accountant Email Address: Authorized Party's Personal Information Name. DOB: SSN: Legal Address City: Country of Citizenship. If not U.S. (check one): 0 Resident Alien K Non-Resident Alien State: Zip/Postal Code: Country: Employment Status: 0 Employed K Self-Employed K Retired K Unemployed K Homemaker K Student Occupation and Position: Employer's Name: Employer's Address: City: State: Zip/Postal Code: Length of Employment: Home Phone Number: Business Phone Number: Investment Experience Investment Type Experience Annual Activity Level (Select one) (Required) Years of Investing None No history of any transactions Limited (1.5 transactions per year) Moderate (615 transactions per year) High (Over 15 transactions per year) Equities Options Fixed Income Mutual Funds Exchange Traded Funds (ETFs) Real Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency Email Address: 2nd Authorized Party's Personal Information Name: Legal Address: City: State: Zip/Postal Code: Country: Country of Citizenship: If not U.S. (check one): 0 Resident Alen 0 Non-Resident Men Employment Status: 0 Employed 0 Self-Employed 0 Retired 0 Unemployed 0 Homemaker 0 Student Occupation and Position: Employer's Name: Employer's Address: City: length of Employment: Home Phone Number: Business Phone Number: Email Address: DOB. SSN: State: Zip/Postal Code: 12-PWM-0355 011224.062212 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0044213 CONFIDENTIAL SDNY_GM_00190397 EFTA01357586