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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)
Indrvduars Name:
Harry Beller
Date of Birth:
Country of Residence:
USA
Country of Citizenship:
USA
Address of primary residence:
Has client resided outside of
his/her country of nationality for
5 years or more>
Yes I
No
Profession/Occupation:
Accountant
Tax ID / SSN:
Current Employer:
HBRK Associates, Inc
Position:Title:Rank
Address of employer:
575 Lexington Avenue, 4th Floor Monsey NY USA 10022
Does the person work as senior executive of a DB•recognized regulated entity in the financial
ndustry' or an entity listed on a DB-recognised exchange? (Not applicable for operating enbties
Yes I
No
Is the individual a Politically Exposed Person (PEP)?(K Ye; desaibe)
,
Yes
I. 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
.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 servrcesp(f
Yegdessiber)
Yes
If applicable, indicate which bank officers have met the person:
Indlate where and when the client meeting(s) took place:
Bank Officer Name(s)
Bank Office:
Client Private
Domicile:
°
Business:
to Place of
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($):
Estimated amount of Investable assets(S):
Estimated Net Worth($):
Amount of assets planned to invest with PWM($):
Other Known Financial Institubons:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
County:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
https://dbforcepb.my.salestorce.comiseNlet,servlet Integration7Id=01N30000000D9Di&eid=50060000001aNty&ic=1&linkTokensVmpFPSxNakF4T1...
18125
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066764
SDNY GM_00212948
EFTA01372863