EFTA Document EFTA01375864

KYC Print Page 17 of 34 One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summa 3A. Individual Details (for all parties) Individual's Name: Harry Beller - Date of Birth: 5/9/1956 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? O Yes rk No Profession/Occupation: Accountant Tax ID / SSN: Current Employer: HBRK Associates, Inc Position/Tide/Rank: Address of employer: 575 Lexington Avenue, 4th Roor Monsey NY United States 10022 Does the person work as senior executive of a DB-recognized regulated entity in the financial industry? (Not applicable for operating entities) D yin g No Is the individual a Politically Exposed Person (PEP)?(if Yes, describe) O Yes No To the best of your knowledge, is the individual related to an employee of the DB group7(if Family or Friendship, descnbe) O Family O Friendship gll 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 services)?(if Ye4descnbe) O Yes WI No If applicable, indicate which bank officers have met the person: Indicate where and when the client meeting(s) took place: Bank Officer Name(s) Bank Office: Client Private Domicile: Client Place of Business: Other Location (specify): Date: ti O O O O 11 O O O Wealth Details for this individual are not filled in, because they are the same as for the following person: 3D. 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: O Business Owner O Salary/Eamings O Investment 11 Other: II Inheritance/Gifts Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did senior 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 asse ts(g): Estimated Net Worth(;): Amount of assets planned to invest with PWM(1,): https://dbforcepb.my.salesforce.com/servlet/senflet.Integration?lid=01N30000000D9Di... 8/2/2018 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0071505 CONFIDENTIAL SDNY_GM_00217689 EFTA01375864