EFTA Document EFTA01387362

Structured Products Agreement and Approval Form Please Complete All Sections s-st- 1c - V_K) .?-\N AN-)c) AL L-Lc Account Type Inc,vottJai Jevn yew% nalltArthil5 Aloly COraiwily Corptyawn arm rumedo NOTE: IRA and ERISA accounts are prohibited from purchasing Structured Products. Accouni and Owns( information: Provide requested inlonnation for evil beneficial account owner Mena If mow Irian one owner exists, the Structured Products Agreement and Approval SUPpit'illeri any Form to ihis Agreement may be tOtIllired. rnotr Naine. fx tnt. 7Additr. Lar.4 Name oi iittlividia Le' Thsidell et E.,...clatar sreicPVL-A GIP sce ).) Mote's 6i (Do go) Mc°, clkac_ "R2 , --r4-)o14\A Us \AEL-st Psi-Mips Mx, Siolus 'Outivicur:i lalalOONYW S\ N GiCe- Acklift.46 4Ns PicsAlq., boa tO Rowtot.s> fit4A MCAAL i PCO144 ics E.:a:hither sek.c HanitiSi InnOrgS) othei filslaccotmi crwner(si glistboi rat to pine met; kx ;he °comsat PP+01.- ; Dottei:J‘ Client(s) Financial Information Approximate Aggregete Sources of Income Approximate Net Worth Approximate Umuid Net Annual Income oi Account (Approximate) Worth Excluding Principal Owneds) from All Solaces Residence Less than $50,000 Salary/Bonus 1s Less than $50,000 Less than 550.000 550,000 - $99,999 Inierest/Oividentis 550.000 - 599.999 550,000- S99,9% $100,000 - $249,999 5100,000-3249.999 4100.000- '''249,999 3250.000 - 5499,999 Other (specify): $250.000 - S499,999 $250,000 - 5499.999 $wami) - S999.999 15 5500,000 - 5999.999 5500.000 - 5999.999 MEM! S3,000.000- 52.499,999 My 51.000.000 - $2.499,999 51.000.000 - 32 499 999 U- 32,500,000 - $4,999,999 52.500.000 - 54,999.999 52.500.060 - S4 999 99t.- 55.000.000 and over 55.000.000 and over 55.000,000 and over 0 Plumb.:, o; Deporkkoti• etiS0*SII)110Oi. Yews i heti vA: mans SPAA ORS( 01 017M3017 Rice CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0089835 SDNY GM_00238019 EFTA01387362