EFTA01372809.pdf

7 5 20t9 1,,YG Punt One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownersh Su nima 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 Has client resided outside of 12 Golar Drive Monsey NY 10952 United States his/her country of nationality Yes 1 No Address of primary residence: for 5 years or more? Profession/Occupation: Accountant Tax ID / SSN: 081-52-0727 Current Employer: HBRK Associates, Inc Position/Title/Rank: Accountant Address of employer: 575 Lexington Avenue, 4th Boor Monsey NY United States 10022 Does the person work as senior executive of a 0B-recognized regulated entity in the financial ndustry? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities ' Yes 1 Ne Is the individual a Politically Exposed Person (PEP)?(ff Yes, descrte) N/A Yes 1 No To the best of your knowledge, is the individual related to an employee of the DB group?(b , Family Friendship 1 None Family or Mends/WA describe) N/A To the best of your knowledge, is the individual party to a non-banking relationship with I, Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or services)? Yes (if Ya,describe) N/A Indicate where and when the client meeting(s) took place: If applicable, indicate which bank officers have met the person: Client Private Client Placed Bank Officer Nernst) Bank Office: Other Location (specify): Date: Domicile: Business: Wealth Details for this individual are not filled in, because they are the same as for the following person: 3B. Wealth Details (Only for parties requiring source of wealth description as indicated ki Section 2) Nature of the Indrvidualts Business: Primary Country of source of wealth/source af Funds? Primary industry d source of Wealth/Source of Funds? Summarize Source of Wealth: Business Owner Salary/Earnings - Investment 1...i Inheritance/Gfts Other: Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For Mists, how did settler accumulate wealth? For inhentance, how did family accumulate wealth7Fof business owners, hew long in business, how many employees, level of profitability? Indicate type of business, countries of major activities, important business partners.) Estimated Annual Income($): Estimated amount of investable assets(;): Estimated Net Worth(f): Amount of assets planned to invest with PWM(S): Other Known Financial Institutions: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: https://dbforcepb.my.salesforce.comiservlet/servlet.integration?lid=01N300000000904w0.5000e00001NOBxm&io= I 8ilinkToken=Vmpf PSxNakFcl. 12'42 CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0066690 CONFIDENTIAL SDNY GM_00212874 EFTA01372809