EFTA01355694.pdf

BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (1) CLIENT HAS RECEIVED. READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION. AND (2) THE INFORMATION CONTAINED IN THIS ACCOUNT APPLICATION IS ACCURATE. CLIENT Ad( Wilats bud-tint ACCOUNT AGREEMENT CONti4NS'TilTAttialitriOifiVirloti Stelli3N PAGE 5. AND ca,teic, AGREES TO IT ERNS IALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL), . INITIAL HERE: THE INTERNAL REWENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING, AND, IF APPLICABLE, THE CERTIFICATION REQUIRED TO ESTABLISH CUBITS STATUS AS A NON-US. PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING. Important Information for ERISA employee benefit plan clients: U.S. Department of Labor regulations reeler° NV to disclose to a responsible plan fiduciary certain information in connection with the services that 0651 provides to a plan, to assist the fiduciary in evaluating the reasonableness of DBSI's services and related compensation. The disclosure is available online, at lutpc/bmwv.pwm db eorNamericas/en/erisa disclosum_poshtml. By signing below, you acknowledge that you area fiduciary responsible for the procurement of DBSrs services to the plan, you have read the asclosure end you understand the disclosure. Individual or joint accoobt 11F THIS IS AJOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN): CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable in any relevant jurisdictions that may wise in connection with assets, income or transactions in Client's account(s) end business relationship with OBSI. CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES. CLIENTS SPECIFY INSTEAD: Tenants in common, or Community Properly for married couples in certain states: each spouse retains 50% interest in the community property upon death of the first spouse). Signature Date Print Name SSWEIN Signature Date Print Name SSN/EIN Signature Date Print Name SSIVEIN CorperretiOn, athrierinip, trust or other entity: CONFIRMATION OF TAX AND COMPLIANCE . . RESPONSIBILMES . . Client acknowledges having solo responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions that may arise in connection with assets, income or transactions in Client's account(s) and business relationship with DEISI. Furthermore, Chant confirms that the necessary information Ito the host of Client's knowledge and capabilities) is made available no lam than annually to the relevant beneficial owner(s), settlorts). .beneficiary(ies). partner(al. etc. to enable such percents) to fulfill any respective toss obligations that may at M for Such PcfPrIalk1.00IMASTi9P Wit, Client's business relationship with Des(. Nome of cnlity Jeepers. Inc No. 66-0629193 * Pinar Officer,, TrUsteg, Atehodatil Oaf. Qtill ( is Print Narneffitle3effreT Epstein• ere, Si Cie .4. Signature of Officer, Penner. Trustee, Authorized Party Date Print NerneMtle Signature of Officer, Partner. Trustee. Authorized Party Date Print Name/Title 13.AWLI.0196 7 012145 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0040946 CONFIDENTIAL SDNY_GM_00187130 EFTA01355694