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Deutsche Bank
Self Certification for Entity Clients
UK Automatic Exchange of Information and the OECD Common Reporting Standard (CRS)
The UK Automatic Exchange of Information (commonly referred to as UK FATCA or UK "AEor) and the OECD Common Reporting Standard
(CRS) require Deutsche Bank AG and its affiliates (collectively 'Deutsche Bank') to collect and report certain tax related Information about
its clients.
Please complete the sections below as directed and provide any additional information as may be required. If the tax residence of an
Account Holder is located outside the country of the Deutsche Bank entity requesting this form and also in a Reportable Jurisdiction then
the Account Holder will be a Reportable Jurisdiction Person and Deutsche Bank is legally bound to report the relevant information on this
form to the appropriate tax authorities
A branch of an Entity is treated as an Entity for the purposes of the CRS and the form should be completed with details for the branch, and
not that of Its parent
This form is for entitles only. Do not complete this form for an Individual Account Holder. Instead you should complete and provide the
Self Certification for Individual Clients which can be obtained from your Deutsche Bank Relationship Manager.
If you have any remaining questions about how to complete this form or about how to determine your tax residency status you should
contact your tax adviser or local tax authority. Deutsche Bank will not be in a position to provide assistance beyond the information contained
within this guide as by taw we are not permitted to give tax advice.
Part 1 — Entity Details
Please complete this pan with Capital Leiters. Fields with (-) are mandatory.
1.
Legal Name of Entity/Branch or Organisation":
...SO
ILAC-rn
Frekrance al
4 LC
2.
Country of Incorporation or Organisation:
3.
Current Residence Address of Entity or Organisation':
(Co not use a P.O. box Mks, this :s )d., /*Of.= adondsjoe al 'in cwo d ad:ben)
Line 1 (e.g. House / Apt/Suite Name/ Number /Street)';
61 MC) Per) 1.1 one
()tsarIT.- II3
Line 2 (e.g. City / Town ) Province / Stater:
S4 Tin o en az
Country':
U
V. ,—y to
I 510 riCh
Postal Code / ZIP Code
00 802
4.
Mailing Address (eorrorwv from too curreornesance moms*
tine 1 (e.g. House/Apt/Suite Name / Number! Street):
tine 2 (e.g. City! Town I Province! State):
Country:
Postal Code / ZIP Code:
5.
Commercial Register Number:
6.
Master Account Number at Deutsche Bank:
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0061766
CONFIDENTIAL
SDNY GM_00207950
EFTA01369484