EFTA Document EFTA01480826

Introduction Type Net Worth of Clint(S) Source Of Wealth / Financial Information Details Source of wealth -Identify he Clients Source of Wealth from followin list of o. ions Other ECI Party Type Party Name Last Completed Search Dale KYC Status Report Type Relation Type Powers Percent Owned Indrvxdual HARRY BELLER Fut Signer Full 00 Primary Information for Client Type HARRY BELLER Individual Generation Client Status awl Active Indicator Yos Front Office Restricted? Normal Marital Status Single Confidential Names? Country of Primary Domicile UNITED STATES Primary Domicile State PrefouTifie Insider Code (Reg 0) First Name HARRY Full Name HARRY BELLER Middle Name Gender Mile Last Name BELLER Date of Birth Suffix Primary Country of Assets Previa° sNamegAMWA liar Citizenship Employer Name High Risk Jurisdiction Occupation Industry Code (NAIC) Years at Occupation Secondary Industry Code (NAIC) Add ress(es) Type Legal Notes Address Country Tools Map it Entered by BATCH 06:12:2011 Preferred No Phone(s)/F. x(s) Notes Phone Number Tools Verily to Nol Call' Lisl Entered b DEBRA J GARVINE Date of U ate 08,O172012 Preferred Yes Cost Center & Hierarchy Ceent Status Client S • •nsor Cost Center Client Service Team Client 118313. IS/T OT CENTER Irbdrmdual Identification Withholding Federal Status Withholding SSN/TIN Certification Date SSNITIN/EIN Form of government issued identification obtained for the Ides Drivers Locense Primary Identification Number Issued By UNITED STATES Now York Date Issued 0599:1956 Expiration Date 05.0912019 Confidential Treatment Requested by JPMorgan Chase CONFIDENTIAL JPM-SDNY-00003053 SDNY_GM_00272251 EFTA01480826