EFTA Document EFTA01392706

pual" 4 • :fr. tthi tz23,; kpa: ngep.ts.t;A279..t.. ,,,t.r...,. • >2>#- . t vx-",. -.: %rags, 41,5? PirId 1.10 7 nt 1 ' 4:4179517 . - l'1442 ''' .4 ,.."F -4.2T.s•-r.44.4*4 ,.?:**-ite --A jm ir. sr " ice Jr .. ..p..e ir i ve% 1 .6. . fa irwt5t -J. ' "/(1.k..- raxecLiC....to,c.14- 4,41.30, 04L, . ..4*, ., *Vn i` 1-rk -t41Xat,"' ;•Whivi'alitte .1.4.M14.k..-Aeap••• . 3ji`frip,.j..cF4Lteet'bw-44 , '111.7'4.1ne 4 • • a chl. •41. )U 2 c 47 Si :4,431 le g;.frte ..3-.70 2...1;;.,5 V, NitiV t ,jjg . a .1> rrtia,:121"lia2er*..1-11biiirt. cFsiec't: 4P17' €i" .1' m; lc' ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and condo(e' of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service II you have selected to receive Internet Banking Services, you understand that you will be required to enter i ito a separate Interest Banking Services Agreement with OBTCA before you can access the Internet Banking Sem ::e. Acknowledgement of Receipt of Privacy Notice By signing beldw, you acknowledge receipt of DBTCA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting dutiai applicable to you in any relevant jurisdictions that may arise in connection with assets, income or transactions in your a :count's) and your business relationship with DBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting dunes applicable to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your accts.:ril(s) and yOur business relationship with OBTCA. Furthermore. you confirm that the necessary information (to the best A your knowledge and capabilities( is made available no less than annually to the relevant beneficial owner(s), senlo.ls), beneficiary(ies), pannor(s), etc. to enable him/her/ them to fulfill any respective tax obligations that may arise 1:" him/her/ them in connection with your business relationship with DBTCA. Please complete and attach separate W-8 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to thi Application and agree to be bound by them. In addition, you agree to notify us immediately of any material cly.nge to the information provided by you on this Application. You represent and warrant that allot the information provided by you on.thls Application is accurate. The Terms and ConcliCnTiot Deposit Accounts are to change. Acceptan You u ersiand that this appl n is subject to accep e by OBTCA unt Holder's Signature Joint Account olders Signature rkt?t, t re1414 Per. Batik," :Fteuievv ittfro*TAXir..;"," 'e4 r ap:,-; Vi"."- WwqrlAWca Y•:i+ Kne:larsitiCir .45 Date Date tO: Wk 1/443. ?1/4". C1 /4 Caibfr. Wit' PA ;T riga p&i X.,Y•Sf.,.192XF-4, 6721,02;j etp-"ZtisliOZXilitief:;Voittestellint' kts,,e.' Iftwalapr: pzeripb,....4.42-tt2p-mh.:Oaaz,..3x;NnwRoawlemIr< rate x.a Tr 1,t.A;34".,;",i,,n5ei, ftlkwyler v tv_its Arri. .4. ' s to" tslf Y,Vta$"1 44,14:54: C6ge,V 841 3 4 13. I WM4101 OM ;9 antis CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0097973 PROT1 PROT0