EFTA01387895.pdf

Deutsche Bank Wealth Management Structured Products Agreement and Approval Form Please Complete All Sections recount Number Aceciam Nan? Account Type IncnMudl .1nInt € Titist Partner ship Limititx: Liability Corr pang Corporation Other (specify): NOTE: IRA and ERISA accounts are prohibited from purchasing Structured Products. Account and Owner Information: Provide requested information tor each beneficial account owner ("Client"). If more than one owner exists, the Structured Products Agreement and Approval Supplementary Form to this Agreement may be required. Entitle Name.. or Nit. Mkhilet last Name of Indlvemal or Trustee or Eeoutor Address COUllUy Phone Number of Dependents MA'AM SUNS Blubdate IttlIrDOgYVYY Employer Business Phone Business Address Tyve of Eta:wits, Portion Years Held Narnefs) of perso0) other than account owner(S) euthenist' to place orders for the 0000tint Client(s) Financial Information Approximate Aggregate Sources of Income Approximate Net Worth Approximate Liquid Net Annual Income of Account (Approximate) Worth Excluding Principal Owner(s) from All Sources Residence Less than $50.000 Salary/Bonus Less than $50,000 Less than $50,000 850,000 - $99,999 Interest/Dividends $50,000 - 599,999 $50,000 $99,999 $100,000 - $249,999 $100,000 - $249,999 $100,000 - $249,999 $250,000 - $499,999 Other (specify): $250,000 - $499,999 $250,000 - $499,999 $500,000 - $999,999 $500,000 - $999,999 $500,000 - $999,999 51,000.000 - $2,499,999 $1,000,000 - $2,499,999 $1,000,000 - $2,499,999 =I= LL $2,500,000 — $4,999,999 $2,500,000 - $4.999,999 $2,500,000 - $4,999,999 = $5,000,000 and over $5,000,000 and over $5,000,000 and over Imo Page 1 ofS CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0091107 CONFIDENTIAL SDNY GM_00237291 EFTA01387895