EFTA Document EFTA01372875

7/15/2019 KYC Print One sheet must be established for EACH INDIVIDUAL PARTY In Section 2. Account Ownership Sum 3A Individual Details (for all parties) Individual's Name: Harry Beller • 00000487202 Date of Birth: 5/9/1956 Country of Residence: USA Country of Citizenship: USA Address of primary residence: 12 Gobi: Drive Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or more? Li Yes Ii No Profession/Occupation: Accountant