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715:2019
KYC Print
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar
3A. Individual Details (for all partes)
Indrviduals Name:
Date of Birth:
Country of Resdence:
Country of Citizenship:
Address of primary residence:
c/o HBRK Associates
•75 Lexington Avenue, 4th Fl New York NY 1O022 USA
Has client resided outside of
lusiher country of nationality for
5 years or more'
I
yes
No
Profession/Occupation:
Tax ID / SSN:
Current Employer:
Position/Title/Rank:
Address of employer:
Does the person work as senior executive of a DBirecognized regulated entity in the financial
ndustry> or an entity listed on a DB-recognised exchange> (Not applicable for operating enbties
ves 1 rto
Is the individual a Politically Exposed Person (PEP)?(Y Yes desaibe)
i , yet
No
To the best of your knowledge, is the individual related to an employee of the DB grouP7(1 FOCI*
cr Friendship, dente)
.
Family
:
Fnendship
I
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 servrcesp(f
Yegdessiber)
Yes
If applicable, indicate which bank officers have met the person:
Magi! where and when the client meeting(s) took place:
Bank Officer Name(s)
Bank Office:
Client Private
Domicile:
Ckent
Busine
Place of
ss:
Other Location (specify):
Date:
0
•
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 in Section 2)
Nature of the Individual's Business:
Primary Country of source of wealth/source of Funds>
Primary industry of source of Wealth/Source of Funds?
Summarize Source of Wealth:
i. • Business Owner
Salary/Earnings
Investment
Inheritance/Gifts
Other:
Further Describe Source of Wealth /Detail the history of wealth fo each of the sources: (e.g. For truss, how did settlor accumulate wealth' For inheritance, how did
family accumulate wealth'For business owners, how long in business, how many employees, level of profitability' Indicate type of business, countries of major
activities, important business partners.)
Estimated Annual Income(S):
Estimated amount of Investable assets(S):
Estimated Net Worth($):
Amount of assets planned to invest with PWM($):
Other Known Financial Institutions:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est Assets Under Mgt:
Institution:
Country:
Eft Assets Under Mgt:
httpe://dbforcepb.my.salesforce.comiseNlet'servlet integrahonThd=0 N30000000D9D4ed=5006000000TIEyC&IcEl&linkToken=VmpEPSxNakFaT. .
18:25
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066738
SDNY GM_00212922
EFTA01372843