EFTA01392757.pdf

ATM/Debit Service You agree that the retention or use of the ATM/Debit card constitutes acceptance of the terms and conditions of the Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts. Internet Banking Service If you have selected to receive Internet Banking Services, you understand that you will be required to enter inn a separate Internet Banking Services Agreement with DBTCA before you can access the Internet Banking Service. Acknowledgement of Receipt of Privacy Notice By signing below. you acknowledge receipt of OBTCA's Privacy Notice included in the Application Package. Non-US Individuals: Confirmation of Tax and Compliance Responsibilities. You Confirm that it is your responsibility to fulfill any lax obligations and any other regulatory reporting duties applicable to you in any relevant jurisdictions that may arise in connection with assets. income or transactions in your account(s) and your business relationship with DBTCA. Non-US Organizations: Confirmation of Tax and Compliance Responsibilities. You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your attount(s) and your business relationship with DBTCA. Furthermore, you confirm that the necessary information (to the best of your knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s), sentons). beneficiary(ies), permi(s), etc. to enable him/her/ them to fulfill any respective tax obligations that may arise for him/hod them in connection with your business relationship with DBTCA. Please complete and attach separate W-8 or W-9 documentation as applicable. Terms and Conditions and Representations By signing below. you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to this Application and agree to be bound by them. In addition. you agree to notify immediately of any material change to the information provided by you on this Application. You represent and variant' et all of the info, tO provided by you on this Application is accurate. The Terms and Conditions for ositAcca t to change. Acceptance You i understand that this ap rication is subject to acceptanCe by OBTCA. 1/ 3e) .AccCiint.tfekkirt PPP 21 403 Joint Account Holder's Signature Date 1.:49,7,-• tj;.r., ii 1.t Pr' feCar,ftlyLFilindLrostiriw. ,..7. 31 ✓ rat- Name . te.k •r. 4@;1.04gI 1•414.‘ reltlaW" 74-t,ntifrxtH:: t - -.% w5 .: tvkCrc• . ,..„ ',tVitfrtlitt"1;r4,*: t• d ?771> fc kFcrlit. M' b- .1." ''.1yrte O9 .ne ;AFCk VIZ% e• 64 . f ei;f1C Vii• .4 1/20 VAP;;Atterrekrtt,03,-Nor... iff p:As!Ste.: 34.1zt. si• Attstilr leGitacG.1: G ' ;$r r *".-Pr3Aret):•r fAiNg ust.r_t9i....wts sr ti .r; Kyt )t, .51 Kt. st. F J OBILA:c • 4, . etsjk. {05:•C : : tyro r..25trrecrV..,MiSs ir".1 ity, rikr fl X11.*g4fORNAtif:. Ar..47.:r4WW:kiie riFrire .P6.3 't°,,1.:_s. .ouptdv -ttito 1.1: PACI. iffiaThier %NOC tor 3 1 •AW -0101 013958 031613 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0098025 CONFIDENTIAL SDNY_GM_00244209 EFTA01392757