EFTA Document EFTA01372809

7 5 20t9 1,,YG Punt One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownersh Su nim a r 3A. Individual Details (for all part es) Individual's Name: Harry Beller - 00000487202 Date of Birth: 5/9/1956 Country of Residence: United States Country of Citizenship: United States Address of primary residence: 12 Golar Drive Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or more? Yes 1 No Profession/O