EFTA01390353.pdf

BY SIGNING BELOW CLIENT ACKNOWLEDGES THATt (t I CUENT 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 *THIS ACCOUNT APPLICATION IS ACCURATE. S THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPLITE ARINTRATON CLAUSE AT SECTION III, PAGE.5. AND CLIENT RMS (ALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL). THE INTERNAL 1YEVENUE SERVICE DOES NOT REOUME CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUIAENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. AND. rAPPLICABLE. THE CERTIFICATION REQUIRED TO ESTABUSH CLIENT'S STATUS AS A NONII.S. PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING. Important Inlormitloh tor ERISA employee benefit plan cents: U.S. Department of labor regulations require DBSI to thicken to a tasponsit4 peen fiduciary certain Information In connection with the smokes that (NISI provides to a Men. tolassist the fiduciary in evaluating the reasonableness ed OBSI'ti cervices and related compensation. the declosure is syeitable online. at http://wsw..pwm.dboorritamencaUenterlse_disclosure_pts hem' By signing below. you acknowledge that you are a fiduciary mainstile for the procurement of ()BSI's senices to the Pan. you have read the disclosure end you understand the disclosure. Individual or loint account CIF THIS IS A JOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN): CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILMES Olsen acknowledges having sole responaiteity to fulfillany tax obligations and any other regulatory reporting duties applicable In any relevant jurisdiction* that may arise in connection with assets. Income or transactions In Client's mccuntisi and business relationship with DES'. CHECK A BOX BELOW ONLY IF CUENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP TM TENANTS BY THE Enil TREWS. CLIENTS SPECIFY INSTEAD: El Tenants in common; of Community Pr0perrir (for marled ecilThrINS in canal Hetes: each spouse retains 50% interest in the contnuaelty Property upon death of the rust spouse). Signature Date Print Name SSN/FJN Signature. Dye Print Name SSISOEIN Signature Date Pnnt Name SSNWEIN Corporaflon, pertnership, true or other antlfr CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES Client ecknowledges haven° sole responsibility to fulfill any tax obligations and any other insulator,/ reporting duties applicable to In any televant NotelictIons that may arise In'connection with assets. income or transactions:in Client's accountis) and business relationship with DEISI. Furthermore, Client confirms that the necessary Intonnation Ito the beet of Clients knowledge end cepatridiesl a made available no less than annually to the relevant beret Wel owners). settled.). benalklerylies). pelmets), etc to enable such potion's) to luatilrany respective tax obligations that may arise to such personlai In connection with Cbenta business relationship wile Desi. Nome of Entity Southern Trial Company be Employe ployst ID No Signature of Officer, Penner, Trustee. Authorized Dg.7 -atia-fa Area NamerritielenreY Epstein Signature of Officer. Pinner, Trustee, Author's! Party Date Print Name/Title Signature of Mow. Partner. Trustee. Authorized Party Date Print NerneAde ISAWM-0196 zuts 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0094832 CONFIDENTIAL SDNY_GM_00241016 EFTA01390353