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7/15:2019
KYC Print
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summary
3A. Individual Details (for all parties)
Individual's Name:
Date of Birth:
Country of Residence:
Country of Citizenship:
Address of primary residence:
301 East 66th st Aptatew york NY 10065 United States
Has client resided outside of
his/her country of nationality for
5 years or more>
yes # No
Profession/Occupation:
Tax ID ; SSN:
Current Employer:
Positionifitle'Rank:
Address of employer:
Does the person work as senior executive of a 06
-recognized regulated entity in the financial
ndusby> or an entity fisted on a DO-recognised exchange> (Not applicable for operating entities
.
Yes I
No
Is the individual a Politically Exposed Person (PEP)?(i Yet; dente)
Yes
I. No
To the best of your knowledge, Is the individual related to an employee of the DB group-Yr Famfee
a - Friendship, desofbe)
1 Family
i : Friendship
ire. None
To the best of your knowledge, is the individual party to a non-banking relationship wth Deutsche
Bank (e.g., edema! legal counsel, client referral source, supplier of goods or serinces)70/
Yesdesolbe)
u Yes
it No
If applicable, indicate which bank officers have met the person:
Indicate where and when the dent mceting(s) took place:
Bank Officer Name(s)
Bank Office:
Client Private
Domkile:
Client Place of
Business:
Other Location (specify):
Date:
(3
1.3
Wealth Deets for this Individual are not filled in, because they are the same as for the following person:
38. Wealth Details (Only for parties requiring source of wealth description as indicated in Secton 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:
•
. Business Owner
Salary/F-amings
. Investment
• Inheritance/Gifts
Other:
Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, 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($):
Other Known F. anal Institutions:
Amount of assets planned to invest wth PWM($):
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
https://dbforcepb.my.salesforce.comiserviet,servlet Integ ration?' id =01 N30000000 D9Di&eici.5003200001 EHPpb&o=1 edinkToken=VmpFPSxNakF4T
14.43
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066800
SDNY GM_00212984
EFTA01372895