Text extracted via OCR from the original document. May contain errors from the scanning process.
7 5 20t9
1,,YG Punt
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownersh
Su nim a r
3A. Individual Details (for all part es)
Individual's Name:
Harry Beller - 00000487202
Date of Birth:
5/9/1956
Country of Residence:
United States
Country of Citizenship:
United States
Address of primary residence:
12 Golar Drive Monsey NY 10952 United States
Has client resided outside of
his/her country of nationality
for 5 years or more?
Yes 1 No
Profession/Occupation:
Accountant
Tax ID / SSN:
081-52-0727
Current Employer:
HBRK Associates, Inc
Position/Title/Rank:
Accountant
Address of employer:
575 Lexington Avenue, 4th Boor Monsey NY United States 10022
Does the person work as senior executive of a 0B-recognized regulated entity in the financial
ndustry? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities
'
Yes 1 Ne
Is the individual a Politically Exposed Person (PEP)?(ff Yes, descrte) N/A
Yes
1 No
To the best of your knowledge, is the individual related to an employee of the DB group?(b
Family or Mends/WA describe) N/A
,
Family
Friendship
1 None
To the best of your knowledge, is the individual party to a non-banking relationship with
Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or services)?
(if Ya,describe) N/A
Yes
I,
If applicable, indicate which bank officers have met the person:
Indicate where and when the client meeting(s) took place:
Bank Officer Nernst
Client
)
Bank Office:
Private
Domicile:
Client Placed
Business:
Other Location (specify):
Date:
Wealth Details for this individual are not filled in, because they are the same as for the following person:
3B. Wealth Details (Only for parties requiring source of wealth description as indicated ki Section 2)
Nature of the Indrvidualts Business:
Primary Country of source of wealth/source af Funds?
Primary industry d source of Wealth/Source of Funds?
Business
Summarize Source of Wealth:
Owner
Salary/Earnings - Investment 1...i Inheritance/Gfts
Other:
Further Describe
did family accumulate
activities, important
Estimated Annual
Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For Mists, how did settler accumulate wealth? For inhentance, how
wealth7Fof business owners, hew long in business, how many employees, level of profitability? Indicate type of business, countries of major
business partners.)
Income($):
Estimated amount of investable assets(;):
Estimated Net Worth(f):
Amount of assets planned to invest with PWM(S):
Other Known Financial Institutions:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
https://dbforcepb.my.salesforce.comiservlet/servlet.integration?lid=01N300000000904w0.5000e00001NOBxm&io= I 8ilinkToken=Vmpf PSxNakFcl.
12'42
CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066690
SDNY GM_00212874
EFTA01372809