EFTA01447991.pdf

Contact Details Telephone Number (Home): Telephone Number (Work): Telephone Number (Cell): Other Telephone Number Fax Number (Home)._ Fax Number (Work): Email Address (1): Email Address (2): CIP Details ID Type: 0 Men Registration Card 0 Driver's License 0 Other Government ID 0 Passport ID Number Date of Issue: Date of Expiration: Country of Issue: Financial Details Annual Income: Net Worth (Excluding Principal Residence): O Less than $50,000 Federal Tax Status: O Less than 650,000 O 50,000-99,999 CI 0-15% CI 50.000-99,999 O 100.000-249,999 CI 15,1-32% O 100,000-249,999 O 250.000-499.999 CI 32.1.60% ❑ 250,000.499,999 O 500,000-999,999 CI 50.1% or more O 500.000-999.999 O 1,000,000-2.499,999 O 1,000,000-2,499,999 O 2600.000-4.999,999 O 2,500.0004999.999 O 5,000,000 and over O 5,000,000 and over Approximate % of net worth that is investable assets (stocks, bonds, etc.)? What % of net worth is Retirement Accounts? Source of Wealth: 0 Inheritance or Gifts O Sale of Securities O Individual Earnings 0 Other (please provide): CI Corporate Executive O Public or Gov't Official ❑ Sale of Real Estate O Sale of Other Assets O Lottery or Gaming O Corporate Earnings O Professional Earnings O Sale of Business O Business Owner Liquidity Needs: 0 Low (Somewhat important) 0 Medium (Important) 0 High (Very important) Time Horizon (approximate year account owner expects to achieve the financial goals for this account): OR 0 10 years or longer Year Investment Experience Investment Type Experience Annual Activity Level (Select one) (Required) None j Limited Moderate High Years of No history (1-5 transactions (6-15 (Over 15 Investing of any per year) transactions transactions transactions I per year) per year) Equities Options Fixed Income Mutual Funds I Exchange Traded Funds (ETFs) Real Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency Hum. 12.FINM.0357 010434.062212 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0102799 CONFIDENTIAL SDNY_GM_00248983 EFTA01447991