EFTA01400629.pdf

Deutsche Bank Private Wealth Management Corporate Account Information Form This form is for informational purposes only. Corporate Details Account Number: Account Title: MAILING ADDRESS ATTN: Address: City: Province/County/Subdivision: State: Zip/Postal Code: Country: Please provide only if P.O. Box is provided above: Business Phone Number: Email Address: Entity Information Type of Entity (check one): o Corporate LEGAL ADDRESS (if different) ATTN: Address: City: Province/County/Subdivision: State: Zip/Postal Code: Country: Client Advisor: Fax Number: o Holding Company o Corporate Pension/Profit Sharing Plan o Financial Organization o LLC o Private Equity Fund o Delaware LLC o Investment Advisor o Venture Capital Fund o Hedge Fund o Government Entity/Agency o Sole Proprietor o Other: Does client waive Deutsche Bank's suitability obligation under Financial Industry Regulatory Authority (FINRA) 2111? o Yes o No Liquidity Needs: o Low (Somewhat Important) o Medium (Important) o High (Very Important) Time Horizon (approximate year account owner expects to achieve the financial goals for this account): OR o 10 years or longer Year 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. EFTA01400629 Equities: Options: Fixed Income: Mutual Funds: Business ID: Number of Authorized Parties: Country of Incorporation: Date the entity was formed or incorporated: Nature of Business: Principal Place of Business: ETFs: Real Estate Property (excluding Primary Residence): Variable Annuities: Alternative Investments (Hedge Funds and Private Equity): Structured Products: Foreign Currency: Tax Identification Number: Is the company publicly traded? o Yes o No State/Province of Incorporation: 12-PWM-0355 011224.062212 EFTA01400630 Entity's Financial Details Annual Income: o Less than $50,000 o 50,000-99,999 o 100,000-249,999 o 250,000-499,999 o 500,000-999,999 o 1,000,000-2,499,999 o 2,500,000-4,999,999 o 5,000,000 and over Net Worth: o Less than $50,000 o 50,000-99,999 o 100,000-249,999 o 250,000-499,999 o 500,000-999,999 o 1,000,000-2,499,999 o 2,500,000-4,999,999 o 5,000,000 and over Entity's Source of Wealth (Check all that apply) o Inheritance or Gifts o Corporate Executive o Sale of Other Assets o Professional Earnings o Sale of Business Entity's Investment Experience Investment Type Federal Tax Status (check one): o 0-15% o 15.1-32% o 32.1-50% o 50.1% or more Approx % of net worth that is investable assets: o Sale of Securities o Public or Gov't Official o Lottery or Gaming o Individual Earnings o Sale of Real Estate o Corporate Earnings o Business Owner o Other (please provide): Experience (Required) Years of Investing Equities Options Fixed Income Mutual Funds Exchange Traded Funds (ETFs) EFTA01400631 Real Estate Property (excluding Primary Residence) Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency Account Investment Objectives/Risk Tolerance Investment Objectives (please select up to two consecutive investment objectives): o Aggressive Growth: Investor is willing 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. o 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. o Income: Investor is willing to accept some risk of loss to the portfolio with exposure to income producing securities in equity, fixed income or equivalent markets. Investor seeks return mainly from income. o 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. None No history of any transactions Annual Activity Level (Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) 12-PWM-0355 011224.062212 EFTA01400632 Banking Account Information Banking Name: Banking Address: City: Banking Phone Number: Accountant Name: Accountant Address: City: Accountant Phone Number: Authorized Party's Personal Information Name: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Position: Employer's Name: Employer's Address: City: Length of Employment: Home Phone Number: Investment Experience Investment Type State: Zip/Postal Code: Banking Email Address: State: Zip/Postal Code: Accountant Email Address: DOB: SSN: State: Zip/Postal Code: Country: If not U.S. (check one): o Resident Alien o Non-Resident Alien o Self-Employed o Retired o Unemployed o Homemaker o Student State: Zip/Postal Code: Business Phone Number: Email Address: Experience (Required) Years of Investing Equities Options Fixed Income Mutual Funds Exchange Traded Funds (ETFs) Real Estate Property (excluding Primary Residence) EFTA01400633 Variable Annuities Alternative Investments (Hedge Funds, Private Equity) Structured Products Foreign Currency 2nd Authorized Party's Personal Information Name: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Position: Employer's Name: Employer's Address: City: Length of Employment: Home Phone Number: DOB: SSN: State: Zip/Postal Code: Country: If not U.S. (check one): o Resident Alien o Non-Resident Alien o Self-Employed o Retired o Unemployed o Homemaker o Student None No history of any transactions Annual Activity Level (Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) State: Zip/Postal Code: Business Phone Number: Email Address: 12-PWM-0355 011224.062212 EFTA01400634 Investment Experience Investment Type Experience (Required) Years of Investing 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 3rd Authorized Party's Personal Information Name: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Position: Employer's Name: Employer's Address: City: Length of Employment: Home Phone Number: Investment Experience Investment Type None No history of any transactions Annual Activity Level (Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) DOB: SSN: State: Zip/Postal Code: Country: EFTA01400635 If not U.S. (check one): o Resident Alien o Non-Resident Alien o Self-Employed o Retired o Unemployed o Homemaker o Student State: Zip/Postal Code: Business Phone Number: Email Address: Experience (Required) Years of Investing 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-0355 011224.062212 None No history of any transactions Annual Activity Level (Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) EFTA01400636 Beneficial Owner's Information Name: DOB or Date of Establishment: Legal Address: City: Country of Citizenship: Employment Status: o Employed Occupation and Position: Employer's Name: Employer's Address: City: Length of Employment: Home Phone Number: Investment Experience Investment Type OR Entity Name: SSN or TIN: State: Zip/Postal Code: Country: If not U.S. (check one): o Resident Alien o Non-Resident Alien o Self-Employed o Retired o Unemployed o Homemaker o Student State: Zip/Postal Code: Business Phone Number: Email Address: Experience (Required) Years of Investing 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 FINRA/Broker Dealer Affiliations (Please Answer All Questions) Is any owner (or person with a beneficial interest in the account) either (1) a senior military, governmental, or political official of any country, or (2) closely associated with or an immediate family member of such an official? o EFTA01400637 Yes o No Are any of the following employed by Deutsche Bank, its subsidiaries or affiliates, employed by a member firm or registered broker-dealer, or employed by FINRA or any other self-regulatory organization? o Yes o No (If Yes, please complete below) Accounts owners? o Yes o No Any member of the same household as the account owner? o Yes o No Any person who materially supports the account owner? Any immediate family member of the account owner? Any person materially supported by the account owner? o Yes o No o Yes o No o Yes o No If you answered YES to ANY of the above, please provide the following: Name of Employee: Name of Employer: Relationship to Account Owner: Is any owner now, or has any owner ever been, a senior corporate officer or director, or does any owner own 10% or more of any publicly-traded company's stock? o Yes o No If YES, provide name of company: Will anyone else be entering orders: o Yes o No If YES, please list name(s) (additional paperwork will be required). 12-PWM-0355 011224.062212 None No history of any transactions Annual Activity Level (Select one) Limited (1-5 transactions per year) Moderate (6-15 transactions per year) High (Over 15 transactions per year) EFTA01400638 Customer Identification Program (CIP) Notice To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. This means that 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 ask to see your driver's license or other identifying documentation. 12-PWM-0355 011224.062212stepvah: Please complete if owner is NOT an authorized person. EFTA01400639