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7,15.2019
KYC Print
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar
3A. Individual Details (for all parties)
Indrvkluars Name:
Harry Bel'er
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 49 No
Profession/Occupation:
Accountant
Tax ID ; SSN:
Current Employer:
Position/Title/Rank:
Address of employer:
575 Lexington Avenue, 4th Floor Monsey NY United States 10022
Does the person work as senior executive of a D6-recognized regulated entity In the financial
ndustry> or an entity fisted on a DC-recognised exchange> (Not applicable for operating entities
.
If
Yes
No
Is the iitvidual a Politically Exposed Person (PEP)?(►trzt dente)
Yes
I. No
To the best of your knowledge, Is the individual related to an employee of the DB grouplinamifY
a Friendship, desofbe)
' Family
1..... Friendship
1 None
To the best of your knowledge, is the individual party to a non-banking relationship wei Deutsche
Bank (e.g., external legal counsel, client referral source, supplier of goods or serrices)70/
Yesdesolbe)
u Yes
it No
If applicable, indicate which bank officers have met the person:
Indicate where and when the dent meeting(s) took place:
Bank Officer Name(s)
Bank Office:
Client Private
pomkile:
Client Place of
Business:
Other Location (specify):
Date:
(3
ii
Wealth Details 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(f):
Estimated Net Worth($):
Other Known F. anal Institutions:
Amount of assess planned to invest wth PWM(S):
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
Institution:
Country:
Est. Assets Under Mgt:
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25.43
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066814
SDNY GM_00212998
EFTA01372905