EFTA00283674.pdf

May. 8. 2014 3:31PM Ashford at Spring Lake No. 1296 F. TD AMERITRADE Paulina Sepulveda Investment Consultant 16830 Collins Ave I Sunny Isles Beach, Florida 33160 Fax Number. MIA 92386 Facsimile Transmittal To: Southern Trust Co Fax From: Paulina Sepulveda Date: 5/8/2014 Re: Forms Client Requested via Fax Pages: 4 CC: ❑ Urgent 0 For Review 3 Please Comment 0 Please Reply Z Please Recycle CONFIDENTIALITY NOTICE: This facsimile transmission is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged. confidential and exempt from disclosure under applicable law. If the reader of this transmission is not the intended recipient, or the employee or agent responsible for delivering the transmission to the intended recipienL you are hereby notified that any dissemination, distribution or copying of This communication is strictly prohibited If you have received this communication in error, please notify us immediately via telephone or facsimile. TD AMERITRADE, Division of TD AMERITRADE, inc., member F!NRA/SIPC. TD AMERITRADE is a trademark jointly owned by TD AMERITRADE iP Company, inc. and The Toronto•Dominion Bank. O 2008 TD AMERITRADE IP Company, Inc. All rights reserved. Used with permission. EFTA00283674 May. 8. 2014 3:37PM Ashford at Spring lake No 1296 P. ID Amentrade Entity Authorized Agent Form PO Box 2209 a Omaha, NE 68103-2209 Fax: Questions' Call a Client Services representative at 800.869.9900 . ['Update to an existing account O New account lfe of tntiy: Southern Trust Co, Inc Elusions Address. (no pi) box 0.modrop) 6100 Red Hook Quarter 83 Ciy. alakx ZIP Code: St. Thomas USVI 0 0 8 0 2 Milling Address: (iNiffvont born above) Cap ZIP Cot: Secondary Ptearec Fax Number. Ernie AddreaS (reqtann tor egecfronic &Wary Of your account Mama,* and trade conirmations): U.S. Entry OFireign Entity - Country CI Formation: SlateThOeinCa of FonrotionfOrgarazation. (c0mPlete appropriate Rim W-8) United States Virgin Islands TypedBusiness; Consulting Is this a Pooled investment Vehicle? Ely. ao If this is a bust account. pYease spec name of Grantor and date of toast:on: Ira Corporate accomt. please indicate if this e en SCorporatloi by checking here..O If this emay is a pub`cly traded company, please s ecify the stock symbol: 2. AUTHORIZED AGENT/PARTNER/TRUSTEEIOFFICER INFORMATIO N Peek( Full Legal Name: IDMr D'ArS. Oa. OD: °Rev. Jeffrey Epstein, President Date of Seth: U.S. toast Secutity Melte( (M4:10-YYYY) (SSt0 Home Adders filoPO bow or meg drop oar. Stale: ZIP Gods. St. Thomas USVI Please specify it you a-a Source of income rat wind otunduniciord): DUnemployed ORetired OllometnaSm ❑Student OSelf.EmplOyed Financier Errarbyer Marne: Occvgatiortrrype of Sushi= Southern Trust Company, Inc. Financier/Consulting ern0lcnrer Sliest Address. csy St. Thomas If none, please submit a pholc00py of your passpat. State: USVI L zPcooe. IIIIIIII IIIIVIIIIIIIVIIIVIIIVIIIIIIIIIII Pal.) 1 ol 3 Tea '.1$7F IN12 EFTA00283675 May. 8. 2014 3:37PM Ashford at Spring Lake No. 1296 P. 3 AUTHORIZED AGENT/PARTNER/TRUSTEE/OFFICER INFORMATION Prefix: Full Legg WOW. OW Deers. OtAs UT). tip:. Date of SAE t1S.Socied Secuny Number: (R1M-OCNYVYY) (SW' Horne Address: foe PO box or madras)) ety: Stare: ZIP Code: Please Specify if you ere: Spume of Income (dmired or invite/ors) DJnemployed Olheired ❑Homemaker ❑Student OSeltEmployed Employer Marne: OordPatForPTYOe Of Ovalness: Employer Street Address: City: State. ZIP Code: 'If none. Pease submit a photocopy Of slur passport. AUTHORIZED AGENT/PARTNERITRUSTEErOFFICER INFORMATION Prefix Full Legal NUM: OW OltAns. 0 hid Olar. QRev. Dale °feints U.S. Social Security Number: (1.44-0D.vvrn (SSAti. Home Address: Ow PO box or matkfrop) City: ZIP Code; Please SPICPy 1 yco are. Scores of income (*soma or uneileSDrecr); rignerhotoyed ORetked ❑Homemaker ClEtudent OSalf-Ernployed ErroplOY•C Nam*: OcouPoliontrYlie Or Business. Employer Street Address City: Stale ZIP Cede 'If nixie. Please submit a photocopy 01 sour passport. Please make Ildthlion21000ies if nnenary 3. AFFILIATIONS O*gun CIviock here r any Pariner/Authonzed Agent, Trustee. Outer. any merrefig of their immediate (entity or any (SPF) Specify NI MOM of the business associate or mess is a senior political Authortted Agent, the neme or the SPF, dOlilcal tide relationship to the Authonzed Agent and country of ace. EICheck hare 4 any Pannerfouthonzed Agent. Trustee or °nicer a a ckectot 10% shareholder or policy-making oftut of a publicly traded company name of the Authorized Agent. the company ticker awned. name, address. city, and enaleforovince. $perry the OCheck hare if any PannernhuthOnzed Agent. Trustee or Order is licensed or employed ty a registered brckeridealler semillFeS securities exchange or nwnher of a exchange. We must receive a compliance letter a Ord with this application. Specify ine nag* of the Authorized Agent: 4. INVESTMENTS PERMITTED The undersigned certify that the entity permits purchases and sales of securities in the following types of accounts as well as all transaction types indicated below: DICash Options:OWrite covered calls, write cash-secured puts areate spreads [' Purchase options Qi Jdrite uncovered options Page 2 dS T3A lig/ F 1Ws2 EFTA00283676 May. 8. 2014 3:37PM Ashford at Spring Lake No 1296 P. 4 5. ACCOUNT AGREEMENT In this agreement, 'Account Owner; 'I' and "ny refer to the entity for which this account is established andfor the natural person(s) authorized to represent and act on behalf of the entity. Under penalties of perjury, I certify (1) that the Social Security Number shown on this form is my Correct taxpayer identification number, (2) that I am not subject to backup withholding, and (3) that I am a U.S. person (including a resident alien); provided, however. If tam a nonresident alien as disclosed in this application. I do not certify that I am a U.S. person and r understand that I must submit a Form W-BSEN. If I have been notified by the IRS that I am subject to backup withholding as a result of dividend or interest underreporting, I must cross out (2) in this certification. I acknowledge that I have received and read the 'Client Agreement,' evadable at wwwidamentradecom or by calling BOO-en-3900, that will govern my account. I agree to be bound by the Tkent Agreement' which may be amended from time to time and which is incorporated by this reference. I release and agree to indemnify and hokl harmless TD Ameritrade. Inc, its divisions and affiliates thereof (70 Amentrade' from any and all liability and Claims for damages resulting from any action taken pursuant to this Agreement. By my signature below. I attest that I am of legal age to contract and that the information contaned in this application is true and correct. The "Client Agreement' applicable to this brokerage account agreement contains predlspute arbitration clauses. By signing this agreement, the parties agree to be bound by the terms of the agreement, including the arbitration agreement located In Section 12 of the Client Agreement. All securities, dividends and proceeds yid be held at TO Ameritrade Clearing, Inc. mien otherwise instructed. I understand that TD Amentrade may obtain a current consumer or credit report to determine my eligibility, or continuing eligibilty, for credit or for other legitimate business purposes My decision by TD Ameritrade to extend credit may be based on iiturnialion contained in a consumer or credo report, as well as the policies of TD Amerltrade Clearing, Inc. I understand that TD Ameritrade may relate information regarding this account, including account delnqueney and voluntary closures, to consumer or credit reporting agencies. Upon my request, TD Amentrade shall inform me of each consumer or credit reporting agency from which they have obtained and/or reported my consumer or credit report TO Ameritrade agrees to notify the consumer or credit reporting agencies d I dispute the completeness or accuracy of the Wormalion furnished by TO Ameritrade. By my signature below, I authorize TO Amentrade to obtain consumer or credit reports for the name(s) set forth below I understand that non-depose Investments purchased through TD Ameritrade are not insured by the Federal Deposit Insurance Corporation (FDIC), are not obligations of or guaranteed by any financial intibilion and are subject to investment risk and loss that may exceed the principal invested. Important Information about procedures for opening a new account: To help the government fight the funding of terrorism and money laundering activities, federal taw requires all financial Institutions to obtain, verity and record Information that Identifies each person who opens en atcount. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to Identify you. We may also utilize a third-party information provider for verification purposes and/or ask for a copy of your driver's license or other identifying documents. The Internal Revenue Service does not require your consent to any provision of this docum►nt other than the certification required to avoid backup withholding. All Authorized Agents, Partners, Trustees and Officers must provide their signatures below. ❑I am the sole officer. ❑Single Member LLC Authorized Agent's Signature: Talc X Authcrizeo Agent's Signeha Tile: Date: X Authorized Agent's Signaturec Tae: Data: Dale: X if his form is being used to update an authorized agent on an existing TO Ameritrade account, then the rescinding Officer needs to Sign below. Resuming Aueirsted Agent's Stgnalure Data: X TO Amentrade, Inc., Treater FINRNSIPCINFA and TD Ameritrade Clearing. Inc., member FINRAISIPC. TD Ameritrade is a trademark jointly owned by TD Ameritrade IP Company, Inc. and The Toronto•Domition Sank. 0 2012 TO Amentrade IF Company, Inc. All rights reserved. Used with permission. Page3c13 70,11100 F teft2 EFTA00283677 May. 8. 2014 3:38PM Ashford at Spring lake No 1296 P. 5 'U Ameritrade Agent Authorization Limited to Account Inquiry PO Box 2760 =Omaha, NE 68103.2760 Fax: This form only grants the ability to inquire about account status, transfers, positions or balances. The undersigned hereby authorizes Authorized Agent (the Triquirme Apert): Acodsa Number(s): (whose signature appears below) as the undersigned's agent to inquire about account stakes. transfers, positions and balances for the underskinecrs account and In the undersigned's name or number on TDAmeritrade's books in accordance with the terms and conditions set forth in the Standard Account Agreement, and three terms end conditions'otherwise established by TD Ameritrade. If the undersigned is a fiduciary on the account, then the undersigned hereby slates and affirms that this authority is granted in such fiduciary capacity and withIn the fektiary powers consistent with the fiduciary duties of said fiduciary. The undersigned hereby agrees to indemnify and held TO Ameritrade harmless from end to pay promptly on demand any and all losses arising therekom or debit balances due thereon. This authorization and Indemnity is in addition to (and in no way limits or restricts) any rights which TDArneritrade may have under any Wier agreement or agreements between the undersigned, the Introducing Broker, and TD Amedtrade. This authorization and indemnity is a continuing one and steel remain in full force and effect until revoked by the undersigned by a written notice addressed to the Introducing Broker and delvered to its office. Such revocation shall not affect any liabiity in any way resulting from transactions initiated prior to receipt by the introducing Broker and the Clearing Broker of written notice of such revocation. This authorization and indemnity shall inure to the benefit of the Introducing Broker and TI) Ameritrade and of any successor firms irrespective of any change or changes at any time in the personnel thereof for any cause whatsoever and of the assigns of the Introdming Broker and TD Ameritrade of any successor M1nu(s). This authorization supersedes any prior inquiring authorization the undersigned may have executed with regard to his/her account with the Introducing Broker and TD Ameritrade. Original Signature required; electronic signatures andlor fonts ere not authorized. ACCOUNT OWNER Printed Name. )( Account Owner Signalise: Dalt; ACCOUNT CO-OWNER (Ii Joan account both winos must sign ) Printed Name. Full Legal Name Date of Binh: Phone Number: fA4M-00-YYYY; Street Address: City State: ZIP Code: Email Address Employer Name Occupation: X Agent Signet"- Investment Products: Not FOIL Insured • No Bank Guarantee ' May Loss Value o Arnow* N , inviter FINRNSIPCM A end TO Amentrade gearing, Mc., MEOW FINRNSIPC. T1) Amentrade 6 a trademark piney owned by TD Amentrade P Comp ny. Inc. d The Toronto-Dominion Bars. Ci 2013 TO Arneneade IP Company, Inc.Ill tips reserved. Used Ain DenneSien. 11111111 1111 11111 IIII IIII III IIIIIII Page toil 'MAO F(013 EFTA00283678