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BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT:11) CLIENT HAS RECEIVED, READ, AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION: AND (2) THE INFORMATION CONTAINED IN THIS
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pertain information In connection with the services
Salad compensation. The disclosure Is available
that you are a fiduciary responsible for the procurement
Individual or joint account (IF THIS IS A JOINT
Client acknowledges having solo responsibility
may arise In connection with assets, income or
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plat clients: U.S. Department of Labor regulations require DBSI to disclose to a responsible plan fiduciary
that DBSI provides to a plan, to assist the fiduciary In evaluating the reasonableness of DBSI's services and
online, at hnp://wwwpwm.db.corn/amolcashinferisa_disdosure_pcsteml. By signing below, you acknowledge
of IMISI's services to the plan. you have read the disclosure and you understand the disclosure.
o fulfill any tax obligations and any other regulatory reporting duties applicable In any relevant lurisdictions that
transactions in Client's accoundsl and business
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Signature
Date
Print Name
SSWEIN
Signature
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Print Name
SS': E N
, . .
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Corporation, partnership, trust or other entity:
Client acknowledges having sole responsibility to fulfill any tax cbigatiom end any other regulatory reporting duties applicable to in any relevant iwisilictreaS
that may ante in connection with assets. income or transactions in Client's accounts) and business relationship will OBSI. Furthermore, Client confirms that the
necessary Information (to the best of Client's knowledge and capabilities) is made available no less than annually to the relevant beneficial ovmerlal, Sehlor43),
benellciaiy(ies), panned.). etc. to enable such person(s) to fulfill any respective tax obligations Mat may arise for such personisl In connection with Client's
business relationship with DBSI.
Name of Entity
Employer ID No.
Signature of Officer, Panne,. Trustee, Authonzed Party
Date
Print Narne/Trtle
Signature of Officer, Panne,, Trustee. Authonzed Party
Dale
Print Name/Title
Signature of Officer. Partner, Trustee. Authorized Party
Date
Pnnt NarnetTitle
12.PWM.0573
7
012145 011113
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
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