Text extracted via OCR from the original document. May contain errors from the scanning process.
ATM/iiebit-SetNiide.
. .. . .
is
yettegrare *that die 'retention or,
.of.the ATM/Debit Card constitutes acceptance 01 tpciernis and conditions of the
Cirditblder Agritienfird:Otattlinedin'the Tenni Arid Ciindidolient. Deposit AscOun ti:
t,
i7
Internet Banking clniicte.
I
If.you have selected to receive Internet Banking:Setvices. You understand thai you will be repaired to enter'into a
i.
itepintie:internatitanicingServices Agreement with DBTCA before you can 8c-equine Internet Banking Service.
t
y
i
e
AcknciWIEdgeriierit Of Receipt of PtVag NOtida:
.
.
.
.
1.
By Signing below., you aeknoWledge leapt of D8TCA's Piivaey Notice jklyded in the Application Shape.
irma
Noij-US Individoafe: Confirmation! of Tax and•Complia
:FiesponSibilities.
nce
..
A
i'oueoptiiin'iluft tt kiwi* leitiorisIbility•tilItfill aoy.tis obligations and env otAerregulitory reporting duties applicable
11
to YetuffT464fifrient Adria:Siena :iliiit.rnaiedite in OtinOittlPit'With easels.: income or transactions In your accounts)
and your' uinnekeisteti0nsin0with ofint.4.
..
•
•
Non-US Organizationt:tonfiertation of Tax end Compliance Responsibilities. .. ..
.
. .
. .. . .
Yeu Confirm that it is your resPonlibilitiriolultilleny tax obligations and any other:regulatory reporting duties applicable
to it in arnerelevantionSdiCtionll IND may arise in connection with assets., income or transactions in' youpaCC0UntD) and
your Wilts relationship with 081CA. Furthertheuer you ccinfini thei.the necesSaiYinforinallon,(t0 the best 01 yoUr
knowledge and Spebilides) s Mader available-no Una than annUany'hithe reirniath beneficial owner(s), sentoiti);
_ .
.
berieficiery(iini, partner(i).*etc. to:enable:hint/her/ them to fulfill any respective tax obligations that may arise kWAIM/hitt
*ern ineonnection with your business relationship With 08TCA.
•
•
Please complete aty4 acted, sepapsSIAS sr 114:9 a'adurriernotiort-al
Terms; and Conditions and Representations
Bysigning bel0W. YOU ticlinoWlidgereeeiPt of the,Teiriii
.APpncaticin and agree to tie bounctby.thern:lOadditiori.'yoriagietto achiiircip lio:rflikotit4?..fi 'f MirrOefiril CneltiOici
iheinfomiation provided by you on this AppliCation.
You represent' nd viinamdiat an of the infoiinatI0n Provided by you an thin AlaPifeetkidifseadait
The Terms end Conditions Tr Deposit Accountsere sit •
tio change.
littepts
41 DBTCA.
aicpount Holders7NInt
JOidtActthilt tidisW's SignstUrir
"
For
Na
Date
Accept
rm.
)3.)4 ° )
Dolt
(
A" p dby D8TCA:
---)D3S112O 47
-;;Titto
D
3
- act—/
'
13-AWM15-0 I 01
013957.0326'3
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
D B-SD NY-0098018
SDNY_GM_00244202
EFTA01392751