EFTA Document EFTA01387987

One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summary 3A. Individual Details 'or all part es. Individual's Name: Date of Binh: Country of Residence Country of Citizenship: Address of primary residence- s client resided outside f his/her country of ationality for 5 years or ore? O yes :hi No Professon, Occupation N A Tax ID I SSN Current Employer: N A Position/Title: Rank Address of employer: N A Does the person work as senior executiv