EFTA Document EFTA01372818

7 5 2019 1\YCi Punt One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownersh Su ram a r 3A. Individual Details (for all parties) Individual's Name: Date of Birth: Country of Residence: Country of Citizenship: Address of primary residence: 301 East 66th St Apttew York NY 10065 United States Has client resided outside of his/her country of nationality for 5 years or more? Yes if No Profession/Occupation: N/A Tax ID / SSN: Current Employer: N/A Posit