EFTA Document EFTA01480540

Source Of Wealth I Financial Information Details Source Of Wealth -Identify he Clients Source of Wealth from followln list of o• Ions Other ECI Party Type Party Name Last Completed Search Date KYC Status Report Type Relation Type Powers Percent Owned 0241469053 Individual HARRY BELLER Full Sone' col C 0 Primary Information for Client Type HARRY BELLER Individual Generation Client Status Prospect Active Indicator Front Office Restricted? Normal Marital Status Confidential Names? No Country of Primary Domicile Fierntrritte Insider Code (Reg. 0) First Name HARRY Full Name b:RRy BELLER Middle Name Gender Lf:ri, Last Name SELLER Date of Birth - SuRi■ Primary Country of Assets PreviousName/PAMNIAl s Citizenship UNITED STATES Employer Name HBRK Associates High Risk Jurisdiction Occupation Financial Advisor Industry Code (NAIC) Individuals [999940) Years at Occupation Secondary Industry Code (NAIC) Address(es) Tyne Notes Address City. State, Postal Code Country Tools Entered by Date of U•date Preferred 301 E 66TH NEW YORK. UNITED Map it DEBRA P1:13,2012 Yes ST APT 108. New York. STATES WHITE 100656298 Phone(s)/Fax(s) Notes Work Phone Number 2123270131 Tools Verify To Not Calr List Entered SYSTEM Date of U ate 04:13/2012 Preferred Yes Cost Center & Hierarchy Client Status Client S • •nsor Cost Center Client Service Team ritarl!!!! PAUL V MORRIS 008834 -CHBG Individual WMMIldngSMMN CoftlicationMite Identification Withholding Federal Status T1 Form of government issued Identification obtained for the files Domestic Certified None SSN/11WEIN 0411312012 081424727 Confidential Treatment Requested by JPMorgan Chase CONFIDENTIAL JPM-SDNY-00002726 SDNY_GM_00271924 EFTA01480540