EFTA01431183.pdf

All Unique Case Number(populated by Lavastorm) Client-ID Matching Engine Private Name Last Name First Name DOB/DOI Nationality (n/a LE) Address Country of registered address (mail adress) Domicile (LE country of incorporation) Role (e.g. AH, PoA, BO) Account ID Account Holder Name Account Holder First Name Client Relationship Manager Question I (for all accounts) Is the account used as a pay-through account? Question I (for all accounts) Has the client signed DB's tax self-certification forms? Question I (for all accounts) Is there a transparent reason that the country of client's bank account (booking location) differs from both the country of incorporation and the country of residence (UBO)? Question I (for all accounts) Is there - apart from the nexus to "Panama Papers" - any other known negative information? Question I (for all accounts) if yes, please specify Question I (for all accounts) Are you aware of any other issues regarding the relationship you want to report? Question I (for all accounts) ... if yes, please specify_O Questions II (for accounts with a legal person as an account holder) Is it an operating company? (i.e. active business in goods, services or trade) Questions II (for accounts with a legal person as an account holder) Is the company part of an offshore construct? Questions II (for accounts with a legal person as an account holder) Is the company part of a complex ownership structure? (e.g. account-holding company is owned by another company) Questions II (for accounts with a legal person as an account holder) Have there been any (frequent) inter-company payments? Final Statement (for all accounts) Having the above questions in mind, should the relationship be maintained? US WM 003187 P02 44130552 BUTTERFLY TRUST BUTTERFLY TRUST N/- A 2006712-27 N/A 6100 RED HOOK QUARTER, B3 ST. THOMAS 00802 UNITED STATES VIRGIN ISLANDS US Virgin Islands US Virgin Islands AH 44130552 BUTTERFLY TRUST BUTTERFLY TRUST STEWART_OLDFIELD For internal use only EFTA01431183