EFTA Document EFTA01387895

Deutsche Bank Wealth Management Structured Products Agreement and Approval Form Please Complete All Sections recount Number Aceciam Nan? Account Type IncnMudl .1nInt € Titist Partner ship Limititx: Liability Corr pang Corporation Other (specify): NOTE: IRA and ER ISA accounts are prohibited from purchasing Structured Products. Account and Owner Information: Provide requested information tor each beneficial account owner ("Client"). If more than one owner exists, the Structured Products Agreement and Approval Supplementary Form to this Agreement may be required. Entitle Name.. or Nit. Mkhilet last Name of Indlvemal or Trustee or Eeoutor Address COUllUy MA'AM SUNS Business Address Tyve of Eta:wits, Blubdate IttlIrDOgYVYY Phone Number of Dependents Employer Portion Narnefs) of perso0) other than account owner(S) euthenist' to place orders for the 0000tint Client(s) Financial Information Approximate Aggregate Annual Income of Account Owner(s) from All Sources Less than $50.000 850,000 - $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 51,000.000 - $2,499,999 $2,500,000 — $4,999,999 $5,000,000 and over Sources of Income (Approximate) Salary/Bonus Interest/Dividends Other (specify): Business Phone Approximate Net Worth Less than $50,000 $50,000 - 599,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 - $4.999,999 $5,000,000 and over Years Held Approximate Liquid Net Worth Excluding Principal Residence Less than $50,000 $50,000 $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 - $4,999,999 $5,000,000 and over =I= LL = Imo CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) CONFIDENTIAL SDNY GM_00237291 Page 1 ofS DB-SDNY-0091107 EFTA01387895