EFTA01372864
EFTA01372865 DataSet-10
EFTA01372866

EFTA01372865.pdf

DataSet-10 1 page 411 words document
P17 P21 V15 D1 V16
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715:2019 KYC Print One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details (for all partcs) Indrvkluars Name: Erika Kellerhals - Date of Birth: Country of Rezdence: USA Country of Citizenship: USA Has client resided outside of hrsiher country of nationality for yes fir No Address of primary residence: 5 years or more> Profession/Occupation: Attorney Tax ID / SSN: Current Employer: Kellerhals Ferguson Kroblin PlIC Position:Title:Rank Address of employer: 9100 Port of Sale Mall, Ste 15 St. Thomas USVI 00802 Does the person work as senior executive of a DB.recognized regulated entity in the financial ndustry' or an entity listed on a DB-recognised exchange' (Not applicable for operating enbties yes ,it No , yes Ir. No Is the individual a Politically Exposed Person (PEP)?(K Yes desaibe) To the best of your knowledge, is the individual related to an employee of the DB grouP7(1FOCI* Family - Fnendship 1 - , None cr Friendship, dente) To the best of your knowledge, is the individual party to a non -banking relationship with Deutsche Bank (e.g., external legal counsel, client referral source, supplier of goods or servrcesp(f Yes —i Yes its Indicate where and when the client metting(s) took place: If applicable, indicate which bank officers have met the person: Client Private dent Place of Bank Officer Name(s) Bank Office: Otter Location (specify): Date: pomicile: Business: I. , 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 in Section 2) Nature of the Individual's Business: Primary Country of source of wealth/source of Funds' Primary industry of source of Wealth/Source of Funds' Summarize Source of Wealth: i. • Business Owner Salary/Earnings Investment Inheritance/Gifts Other: Further Describe Source of Wealth /Detail the history of wealth fo each of the sources: (e.g. For truss, how did settlor accumulate wealth' For inheritance, how did family accumulate wealth'For business owners, how long in business, how many employees, level of profitability' Indicate type of business, countries of major activities, important business partners.) Estimated Annual Income($): Estimated amount of Investable assets(S): Estimated Net Worth($): Amount of assets planned to invest with PWM($): Other Known Financial Institutions: Institution: Country: Est. Assets Under Mgt: Institution: County: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: https:ildbforcepb.my.salesforce.comiseNlet,serviet integration7ild=01N30000000D9Di&eid=50060000001aNfy&ic=1&linkTokenaVmpFPSzNakF4T1... 20:25 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0066766 CONFIDENTIAL SDNY GM_00212950 EFTA01372865
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EFTA01372865
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DataSet-10
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document
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1
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