EFTA Document EFTA01480846

Introduction Type Net Worth of client(S) Source Of Wealth I Financial Information Details Source Of Wealth -Identify the Clients Source of Wealth from follovAn. list of • • Ions ECI Party Type Party Name Last Completed Search Date KYC Status Report Type Relation Type Powers Percent Owned Individual HARRY BELLER Ful Signer Full 0.0 Primary Information for Client Type HARRY BELLER Individual Generation Client Status Client Active Indicator Yos Front Office Restricted? Normal Marital Status Single Confidential Names? Country of Primary Domicile UNITED STATES Primary Domicile State Prefix/Title Insider Code (Reg. 0) First Name HARRY Full Name HARRY BELLER Middle Name Gender Last Name BELLER Date of Birth allill Suffix Primary Country of Assets PrevlousNamenAMNiAllas Citizenship Employer Name High Riek Jurisdiction Occupation Industry Code (NAIC) Years at Occupation Secondary Industry Code (NAIC) Address(es) ;Pk Work Notes Address Tools Map it Entered by SYSTEM Date of U to 0&12/2011 Preferred Yes Cost Center & Hierarchy Client Status Client S nsor Cost Center Client Service Team Client 118313 IVT OT CENTER Individual Identification Withholding Federal Status Withholding SSNII1N Certification Date SSNMWEIN Form of government issued Identification obtained for the files Drivers License Primary Identification Number Issued By UNITED STATES New York Date Issued 05.09/1956 Ex • !ration Date 05/092019 Confidential Treatment Requested by JPMorgan Chase CONFIDENTIAL JPM-SDNY-00003077 SDNY_GM_00272275 EFTA01480846