EFTA01390363.pdf

BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (1) 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 APPLICATION IS ACCURATE. CLIENT Ad( Wilats bud-tint ACCOUNT AGREEMENT CONti4NS.KITAttialitgAteirIVirldt4 trrlAUSE AT SECTI3SN IdT, PAGE 5. AND ca,teic, AGREES TO IT ERNS IALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL), . INITIAL HERE: THE INTERNAL REWENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING, AND, IF APPLICABLE, THE CERTIFICATION REQUIRED TO ESTABLISH CUBITS STATUS AS A NON-US. PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING. Important Information for ERISA employee benefit plan clients: U.S. Department of Labor regulations require OBSI to disclose to a responsible plan fiduciary certain information in connection with the services that 0651 provides to a plan, to assist the fiduciary in evaluating the reasonableness of DBSI's services and related compensation. The disclosure is available online, at lutp/bmwv.pwm db conVamericas/erVerisa_discloswe_pce.html. By signing below, you acknowledge that you area fiduciary responsible for theprocurement of DBSrs services to the plan, you have read the asclosure end you understand the disclosure. Individual or joint accoobt 11F THIS IS AJOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN): CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable in any relevant jurisdictions that may wise in connection with assets, income or transactions in Client's account(s) end business relationship with OBSI. CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES. CLIENTS SPECIFY INSTEAD: Tenants in common, or Community Properly for married couples in certain states: each spouse retains 50% interest in the community property upon death of the first spouse). Signature Date Print Name SSWEIN Signature Date Print Name SSN/EIN Signature Date Print Name SSalrEIN CorperretiOn, athrierinip, trust or other sniffy: CONFIRMATION OF TAX AND COMPLIANCE . . RESPONSIBILITIES . . Client acknowledges having solo responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions that may arise in connection with assets, income or transactions in Client's account(s) and business relationship with OBSI. Furthermore, Chant confirms that the necessary information Ito the host of Client's knowledge and capabilities) is made available no toss Then annually to the relevant beneficial owner(s), settlor(s). .beneficiary(ies). partnedal. etc. to sable such person(s) to fulfill any respective !ex. obligations that may Or* for such 'wim(a) Inconstegban. with Client's business relationship with Des(. tonic of Entity Jeepers. Inc *Rini' el No. Signatory of Officer,Partner. Triistoo, C Print Name/Title EPRoirl . ire. Si Of ti Signature of Officer, Penner. Trustee, Authorized Party Dote Print NarneMtle Signature ol Officer, Partner. Trustee. Authorized Party Delo Print Name/Title i3.AWM.0196 7 012145 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0094845 CONFIDENTIAL SDNY_GM_00241029 EFTA01390363