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📄 Extracted Text (360 words)
II. Certification of beneficial owner(s)
Persons opening an account on behalf of a legal entity must provide the following information:
a. Name UM Title of Nato! ai Pei son Opening Accou,lt
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b. Name cf Legal Ernity. Type of Legal Entav, and Addiess of Lega: fiN;ty *ex What the Accorag. is &Jug Opened:
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c. The foikmeing infexmation for each inds4dual, if any, MK:. directly or indirectly, thro;x3n any contract 3rrangement.
understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity fisted above:
Dr." 5iCt!, A;L:, f70. , or S Potnez 7,1 Noe....14$ amront;
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rAl Sock, Seoutin- 71Jrntitt:
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l 40 4 Crect4)en..noOdot tl to a' ni 4 tioubri with coorr, at ojamit. An Oho bertnibzunCld, Mid DtattAit :1,1Mbt:
iNACOUitire or imurrirJo of 3m, (Kew go.weir•ev.mstu-xf &tuner, eviomainq nanorohtv or Ieldttenrd ono S'aretga 04NagiKS! .31 :Rd JiSltila
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ill no irkir.flautt rtitre this anisuntiti. Ottiot.ver!to tketottr4rbil.1
0. The following Information for one individual with significant responsibility for managing the legal 4ntIty listed above,
such as:
• An executiw, officer or sencr manager kg.. Chief Exc-anive Officer. Chief Financial Officer. Chief Operadng °freer.
Managing Member, General Partner. President. Vice President. Treasurer); or
• Any other 'individual who regularly performs sktilar functions
(If appropriate, an individual listed Under SW1O1% (ra abuve may also be listed in this station
:)Jo cif birth t4,O Atte.es: kw v S. Airsone: rn.
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Joit* , r.* VC'S St'Veit, %.tintAtil
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;tor NunALS, PdrAwn. arAidion to xi art"-A Se iv Piairibtr l'aSspnet eraiti,txtenry of inntonw. tip ti2r4:erdzooaber paimber tt nure,xx
cocintr; of isitheer* i)f err; trAvs of4J&CIAIIIPri twideitt:ttig ntionnttlitn or itirEttiltlitirtlfflarbtri • 00004 4041 e4 IMMO altSu d avoid
frey.a.W.
(name of natotal person opening the account), hereby certify. to toe heat of
:omplete and correct.
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CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0077154
CONFIDENTIAL SDNY_GM_00223338
EFTA01379561
ℹ️ Document Details
SHA-256
2557b8860a4d4793da5be1b00bf1195c0a2f0ebde26c562ffcf51f96ac2fda2e
Bates Number
EFTA01379561
Dataset
DataSet-10
Type
document
Pages
1
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