EFTA01357587.pdf

Investment Experience Investment Type Experience Annual Activity Level (Select one) (Required) None Limited Moderate High Years of No history (1-5 transactions (6-15 (Over 15 Investing of any per year) transactions transactions transactions per year) per year) Equities Options Fixed Income Mutual Funds Exchange Traded Funds (ETFs) Heal Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency 3rd Authorized Party's Personal Information Name: DOB. SSN: Legal Address: City: State: Zip/Postal Code: Country: Country of Citizenship: If not U.S. (check one): O Resident Alien O Non-Resident Alien Employment Status: O Employed ❑ Self-Employed ❑ Retired O Unemployed O Homemaker ❑ Student Occupation and Position: Employer's Name: Employer's Address: City: State: Zip/Postal Code: Length of Employment: Home Phone Number: Business Phone Number: Email Address: Investment Experience Investment Type Experience Annual Activity Level (Select one) (Required) None Limited Moderate High Years of No history (1-5 transactions (6-15 (Over 15 Investing of any per year) transactions transactions transactions per year) per year) _ Equities Options Fixed Income Mutual Funds Exchange Traded Funds (ETFs) Real Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency 12-PWM-03 55 011224.062212 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0044214 CONFIDENTIAL SDNY_GM_00190398 EFTA01357587