EFTA Document EFTA01480833

Introduction Type Net Worth of client(S) Source Of Wealth / Financial Information Details Source Of Wealth -Identify he Clients Source of Wealth from followini list of • • Ions ECi Party Type Party Name Last Completed Search Date KYC Status Report Type Relation Type Powers Percent Owned Individual HARRY BELLER Fur Signor Full 0.0 Primary Information for Client Type HARRY BELLER Indivkluel Generation Client Status Client Active Indicator Yes Front Office Restricts? Normal Marital Status Single Confidential Names? Country of Primary Domicile UNITED STATES Primary Domicile State Prefix/Titte Insider Code (Reg. O) First Name HARRY Full Name HARRY BELLER Middle Name Gender Last Name BELLER Date of Birth Suffix Primary Country of Assets PreviousName/MMN/Ahas Citizenship Employer Name High Risk Jurisdiction Occupation Industry Code (NAIC) Years at Occupation Secondary Industry Code (NAIC) Address(es) Type Notes Address Country Tools Map it Entered by SYSTEM Date of U e 05/12/2011 Preferred Yes r hone(s)/Fax(s) Notes Phone Number Tools Verify to Nol Call' List SYSTEM 05/12/2011 Preferred Yes Cost Center 8, Hierarchy Client Status Client S nsor Cost Center Client Service Team Client 118313 - IVT OT CENTER A' Individual Identification Withholding Federal Status Withholding SSNRIN Certification Date SSNiTIN1EIN Form of government issued Identification obtained for the files Drivers License Primary Identification Number Issued By UNITED STATES Nee: Yofk Date Issued Ex •Iration Date 2019 Confidential Treatment Requested by JPMorgan Chase CONFIDENTIAL JPM-SDNY-00003061 SDNY_GM_00272259 EFTA01480833