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📄 Extracted Text (455 words)
BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT:11) CLIENT HAS RECEIVED, READ, AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION: AND (2) THE INFORMATION CONTAINED IN THIS
ACCOUNT APPUCATION IS ACCURATE.
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THE INTERNAL EVENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP IMTHHOLDING, AND. IF APPUCABLE, THE CERTIFICATION REQUIRED TO ESTABLISH CLIENTS STATUS AS A NON-U.S.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Infonnation for ERISA employee benefit plat clients: U.S. Department of Labor regulations require DBSI to disclose to a responsible plan fiduciary
Certain information In connection with the services that DBSI provides to a plan, to assist the fiduciary In evaluating the reasonableness of DBSI's services and
Salad compensation. The disclosure Is available online, at hnp://wwwpwm.db.corn/amolcashinferisa_disdosure_pcstamt By signing below, you acknowledge
that you are a fiduciary responsible for the procurement of IMISI's services to the plan. you have read the disclosure and you understand the disclosure.
Individual or joint account (IF THIS IS A JOINT ACCOUNT. ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility o fulfill any tax obligations and any other regulator/ needing duties applicable In any relevant lurisdictions that
may rinse In connection with assets, income or transactions in Client's accoundel and business kinship with 089.
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Signature Date
Print NMITO SSWEIN
Signature Date
Print Name SSE N
, . . ..
Corporation. partnership, trust or other entity:
CONFIRMATION OF TM AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax cbtigatiom end any other regulatory reporting duties applicable to in any relevant iwistlicti0nS
that may ante in connection with assets. income or transactions in Client's /comings) and business relationship with OBSI. Furthermore, Client confirms that the
necessary Information (to the best of Client's knowledge and capabilities) is made available no less than annually to the relevant beneficial ovmerisl, SettloelS),
benellciargies), panned.). etc. to enable such person(s) to fulfill any respective tax obligations Mat may arise for such person(s) In connection with Client's
business relationship with DBSI.
Name of Entity Employer ID No.
Signature of Officer, Panne,. Trustee, Authonzed Party Date
Print Narne/Trtle
Signature of Officer, Panne,, Trustee. Authonzed Patty Dale
Print Name/Title
Signature of Officer. Partner, Trustee. Authorized Party Date
Pnnt NarnatTitle
12.0WM.0573
7 012145 011113
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0094883
CONFIDENTIAL SDNY_GM_00241067
EFTA01390390
ℹ️ Document Details
SHA-256
0eec1a9db0639c62ba3a553cdfc7de0e51c87763cfc548df062c5138b51de5dd
Bates Number
EFTA01390390
Dataset
DataSet-10
Type
document
Pages
1
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