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DBSI High Risk Media Communication Sheet
. I - Account Number(
Type of Account Change:
Address of Record
Telephone Number
E-mail
Type of Asset Movement:
USD WIRE
NON-USD WIRE
ACH
CHECK
JOURNAL
DTCJEUROCLEAR
Reg E Wire (If marked, complete and attach additional documentation required.)
Standing Instructions (select one):
Initial Setup
Pre-Established
II . DocaSign (all amounts)—Proceed to Section IV once complete
I processed the request via the Knowledge Based Authentication (KBA)
I recognized Client's voice and verbally provided the Access Code via outbound call to a phone number on file
(Complete the details of the outbound call below.)
III- Non-DocuSign—Verification of Contact with Client—By signing below. lam certifyino the following:
L I recognized the Client's voice based on prior conversations, OR
confirmed accurate responses to three authent
questions
Callback Determination/Rationale—Circle—YES'', NO andfcheck the appropriate rationale adjacent
(each YES or NO response must be accompanied
asking the applicable rationale)
NO Reason
Callback is not required for pre-established standing instructions on tile
Callback is not required for same name internal asset transfers
USD Domestic Funds/Asset transfer s$50X (Verbal Instructions)
YES Reason
Initial standing Instructions
Non-USD FX transactions
Funds/asset transfer to International locations
USD Domestic funds/asset transfer 450K (Written LOA or email instructions)
USD Domestic funds/asset transfers 450K
€ Account changes such as, address, phone, email
IV- I confirm
• Signer(s) is/are aumortzeci to act on account
• I have reviewed this transaction for consistency
with Client's historical/expected account activity
• I have completed signature verification (non-DOCuSign only)
• Indemnitication language is on file (non-DocuSIgn only)
V - Additional information
Asset movement amount: $6,°°°,000
Same Name Internal
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Branch Management Approval is evidenced in NetX in accordance with HRM Policy.
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BSO Approval (if necessary) Is evidenced in NetX in accordance with HRM Policy.
IMO
• The term "Client" refers to the account holder or any individual who has been authorized by Client to transfer assets or
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provide change of contact information. Please refer to the High Risk Media Policy--Deutsche WM Americas, USA.
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WM ()BSI for more information: htips:lidlopolicyportalintranet.db.comigpagiodf/0G0leSbe802112d6/filenarnejs_nulivil
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fa 201) Do•Aeleta Stet AG. An rights reserved. WtAV032fAt 014S36 110517
For Internal Use Only
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CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0054024
SDNY_GM_00200208
CONFIDENTIAL
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