EFTA01447992.pdf

Total Investments Please note the investment types in which Client currently invests or owns (whether with DBSI and/or with other financial institutions) by indicating the estimated value of those investments. Equities: ETEs: Alternative Investments (Hedge Funds and Options: Real Estate Property Private Equity): Fixed Income: (excluding Primary Residence): Structured Products: Mutual Funds: Foreign Currency: Variable Annuities: Investment Objectives/Risk Tolerance (please select up to two consecutive investment objectives): ❑ Capital Preservation: Risk averse investor who is willing to accept limited risk of loss to the portfolio with limited exposure to equity markets risk or equivalent risks. The objective is capital preservation with limited potential for capital appreciation and current income. Investor seeks stability and a modest return on capital. ❑ Income: Investor is willing to accept some risk of toss to the portfolio with exposure to income producing securities in equity, fixed income or equivalent markets. Investor seeks return mainly from income. ❑ Growth: Investor is willing to accept increased risk of loss to the portfolio with greater exposure to the equity markets or equivalent markets. The objective is long-term growth of capital. Investor seeks return mainly from capital appreciation and/or higher yielding instruments. ❑ Aggressive Growth: Investor is wiling to accept substantial risk of loss to the portfolio to obtain growth of capital with minimal or no current income. Investor seeks return mainly from potential capital appreciation; liquidity is of no primary concern. Primary Bank Name:JP Morgan Years with Institution: Address: City: New York State:NY Zip: Do you have brokerage accounts with other firms? ❑ Yes ❑ No If Yes, please list fine name(s): JP Morgan Does the owner have any other DB accounts? ❑ Yes ❑ No If Yes, please list account numbefis Miscellaneous Information (optional) Accountant Name: Accountant Address: City State: Zip/Postal Code: Accountant Phone Number Accountant Email Address: Attorney Name: Attorney Address: City: State: Zip/Postal Code: Attorney Phone Number. Attorney Email Address: Assistant Name: Assistant Address: City: State: Zip/Postal Code: Assistant Phone Number: Assistant Email Address: Is this account owner or participant. ❑ Yes ❑ No — A senior military, governmental or political official of any country? — Closely associated with or an immechate family member of such an official? Is this account owner or participant a governmental entity: ❑ Yes ❑ No — Any branch, department, agency, public authority, board or commission of federal or state local government? — An employee of a governmental entity? — A public official (i.e. any person elected or appointed to a public office)? Is this account owner or participant a public entity: ❑ Yes ❑ No — A department or agency of a government (i.e., Department of Housing. Agency on Aging)? — A commission, authority, or boards of a government. They can be independent of the executive branch (i.e. retirement systems. pension boards)? — Created by state or local law (i.e. state universities)? — Owned by a government? — Senior corporate officer/director, or own 10% of publicly traded company stock. etc. 12-PWM.0357 010434.062212 CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0102800 CONFIDENTIAL SDNY GM_00248984 EFTA01447992