EFTA01480377.pdf

0 CHASE PERSONAL SIGNATURE CARD AM) APPLICATION JPMorgan Chase Bank BRANCH COPY Account Title Primary Customer Information (Accounts with multiple owners are John, parable to either owner or the survivor.) Home Ph (0301000-0000 Account I Account Type CHASE EXTRA SAVINGS ACCOUNT Malden N DIVIDUAL Birth DateafTEN Account An, SSI/TIN Date Opened 02/19/M4 Opened By PHILLIP WAITERS Deposit And $0.01 This Account IS Not Transferable Please activate Check Coverage for the account listed above. Uwe authorize you to integrate and use as the application. Uwe agree to the terms and Protecting Account(s)' the account(s) identified above on this conditions as contained in the Deposit Account Agreement and Disclosures. Application !Ave agree that I/we have reviewed the information contained in this Personal Signature Card and other business relative and find it accurate on this date. In the payment of hinds and in the transaction of all below and on the to this account. lAve agree that you are authorized to rely upon the signature(s) written -_reverse.side._Uvre.have.re ceived.and.ag ree.to_the.term s_and_condito ns of the Deposit Account Agreement Uwe seicacd— ano Disclosures currently in Out and as may be amended fur the type of Ut-ourit andservicos will be above. If I/we do not have a Chase Banking Card, Uwe will be issued one/two and all eligible accounts accounts, whether singly or jointly owned, can be accessed by the linked to it/them. These linked Chase Banking Cud or by telephone. During the review of my/our application, you may obtain a consumer additional report on me/us and if the appliCatlon Is approved, you may at any time in the future obtain consumer reports to review my/our account. Wm have the right to ask for the name and address of the mer reporting agency which gave the consumer report. Joint Applicant Signature 9 Certification By signing below. I certify under penalties of perjury that (1) The number shown on this form Is my correct taxpayer identification number; and (2)1 am not subject to backup withholding because (a) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (b) the IRS has notified me that I am no longer subject to backup withholding; and, (3) I am a U.S. person (including a U.S. resident alien). [ I Check here if you are subject to backup withholding for failure to report interest or dividends. Check here if you are not a U.S person (r a U S. resident aren), and complete the appropriate Form Joint Applicant Signature X malting or o ec s eme e authorize you not to return paid cheats with my/our account statements. If Uwe selected the Check imaging option, Mu agree to receive Images (front only) of my/our paid checks. I/We agree that the account statement will contain information about each check paid, including check number, dollar amount and date paid, thereby enabling a proper reconciliation of the account. You will not retain original checks. Joint Applicant Signature X Check here if there ere edditlonal signers on the reverse side of the BRANCH COPY. THE ABOVE iNFOAKWIllilti AND (P40.) ,SIGNATURC(S)(FRDEARY AND IF APPUCABLI)WER2 VERIRE0 SY: Peen Pan t -'7f: I/ if LIPII-41.0.4 triOrts Dept NoRk. Ma.: '7 Yi BRANCH COPY-Raterscard ontnen tot one frier aft account doses Than and to Foam for 1106IFFM4 nation cillbssirs • Confidential Treatment Requested by JPM-SDNY-00002517 JPMorgan Chase CONFIDENTIAL SDNY_GM_00271715 EFTA01480377