EFTA01392753.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 into 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 tax obligations and any other regulatory reporting duties applicabN to you in any relevant jurisdictions that may arise in connection with assets, iccomo or transactions in your accounts) and your business relationship with MICA 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 accounts) and your business relationship with 087CA. 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). settlor(s). beneliciaryeesk panner(s), etc. to enable him/her/ them to fulfill any respective tax obligations that may arise for him/her/ them in connection with you' 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 us immediately of any material change to the information provided by you on this Application. You represent and warrant that all of the information Provided by you on this Application is accurere. Deposit Accounts are su -to-change. Joint Aram./ HO/den signature Forilenk se On y Reviewed by: Na • Title t3 'Date. .me' : Tide • Dtqe /3 Ascii)) fit: A Na itt' Rib N0C. • Data /3.AWNI.0101 0/3,59.032013 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0098021 CONFIDENTIAL SDNY_GM_00244205 EFTA01392753