EFTA Document EFTA01392761

ifor.pa ght . Wfibr h:WirrAtin alltar‘er a.,W4Witargagrar - ?MI* r 'et: , • . I kiiihrcrr 4koi fp• Prn• N it i Cr 48 ."'" gfi lci".r heat rtsI 4M Fvr liti elefA r ba l lrea ° MaI S7ritA NIP " 4 ipe i;•aP•• 4.% • al • (' k • S4' $!.. 00, Oats Date afig :7st' Vpis 4 ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service If you have selected to receive Internet Banking Services, you understand that you will be required to enter into a separate Internet Banking Services Agreement with DBTCA before you can access the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below, you acknowledge receipt of OBTCA'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 duties applicable to you in any relevant jurisdictions that may arise in connection with assets. income or transactions in your account(s) and your business relationship with OBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that h is your responsibility to fulfill any tax ebligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your accountls) and your business relationship with DIITCA. Furthermore. you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s), settlor(s), beneficiarybes), partner(s). etc. to enable hirrJher/ them to fulfill any respective tax obligations that may arise for himrher/ 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 this Application and agree to be bound by them. In addition, you agree to notify us immediately of any material change to the information provided by you on this Application. You represent and warrant that all of the information pro ed-byTaiiiii on this Application is accurate! The Terms and Acceptance You understand that thi aunt Holder's Signature r Deposit Acc are subject to change Joint Account Holder's Signature V.IMPIrtrtra.%4,,eztu-r ys f rieO.k*SeW ‘$:: ;tar OXG •n145tis r3a - • 4, age 4411.** -sitvire "dtaigni.gt4;T:v4azgese- itaHra Ape 't • w to: , O.1F t:IslitaAian effaaitt 'Sr* .N; ntilt (Ve 4a' WitigiS Woe talaitekal wavar .01.fr 3 1C9.024, :_,174 714- ;air We i r e'resAAW I V . 13.AWM43101 013959032613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0098029 SDNY_GM_00244213 EFTA01392761