EFTA Document EFTA01428153

11. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the follovwing information: a Name and Title of Natural Person Opening Account: b. Name of Legal Entity. Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: ■ WTf r r t?\00 &3 ^ V > TVvctwi," ^ "X"c- c. The following information for each individual, if any. who. directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name Date of Birth Legal Address For U.S. Persons; Social Security Number For Non-U.S. Persons: (See footnote 1 for alternatives to Social Security Number) C"\OC 53 ■.54-- Oe>" 1 0'=ic-V'/-3343 I 9ols3 ' For Non-U.S. Persons, in addition to a Social Security Number or a Passport Number with Country of Issuance, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard should be provided. (If no individual meets this definition, please write "Not Applicable.') d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as: • An executive officer or senior manager (e.g.. Chief Executive Officer. Chief Financial Officer. Chief Operating Officer. Managing Member. General Partner, President. Vice President. Treasurer); or • Any other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). EFTA01428153 Name Date of Birth For U.S. Persons: Social Security Number For Non-U.S. Persons; (See footnote 1 for alternatives to Social Security Number) Legal Address • For Non-U.S. Persons, in addition to a Social Security Number or a Passport Number with Couiitiv of Issuance, an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard should be provided. (name of natural person opening the account), hereby certify, to the best of my knovt/iedge. that the information provided above is complete and correct. 2'" I i 3 • V X A Signature Date "/// " Name (Print): "itlr? Legal Entity Identifier (Optional) 02018 Deutsche Bank-AG. All rights reser\'ed. WM189666 026819.051318 7 7 EFTA01428154