EFTA01447990.pdf

Deutsche Bank Pri•dnto Wealth Manager nt Client Information Form Please complete this form for each participant of the account you are opening. This form is for informational purposes only. Personal Details Client Name/Entity Name. Jeffrey Epstein Birth Date. January 20. 1953 Social Security/Tax ID Number of Dependents: Marital Status ❑ Single ❑ Married ❑ Divorced ❑ Wdowed ❑ Separated ❑ Co-Habitation ❑ Common Law Legal Address' Mailing Address (II different) Ate. Jeffrey Epstein ATTN• Address: 6100 Red Hook Quarter B3 Address: City: St. Thomas State: Zip/Postal Code: 00802 City: State: hp/Postal Code: Province/County/Subdivision: Country: USVI Province/County/Subdivision: Country: •A P.O. Box is not permitted as a legal address. Other Address ATTN: How long at legal address {Years)? Address: Country of Citizenship: Country of Permanent Residence: Governing State of Lay (if entity): City State: Zip/Postal Code: Establishment Date (if entity): Province/County/Sutxlivision: Country: L_ Employment Details Employment Status: ❑ Employed ❑ Retired ❑ Homemaker ❑ Self-Employed ❑ Unemployed ❑ Student Company Name: Southern Financial, LLC Talc/Position: President Company Address. 6100 Red Hook Quarter B3 City. St Thomas State: Zip/Postal Code: 00802 Province/County/Subdivision. Country: USVI Nature of Business: Occupation: How long employed at current company? Are you an employee of Deutsche Bank (DB), its subsidiaries or affikates? ❑ Yes ❑ No If Yes, list name of DB employer. Are you related to an employee of DB, its subsidiaries or affiliates? ❑ Yes ❑ No If Yes, list name of employearrelationship/name of DB employer: Are you an employee of another broker-dealer? ❑ Yes ❑ No If Yes, list name of brokerdealer. Are you related to an employee at another broker-dealer? ❑ Yes ❑ No If Yes, list name of broker-dealer/name of employee: Are you an employee or related to an employee of Financial Industry Regulatory Authority/other self-regulatory organization? CI Yes ❑ No If Yes, list person and organization: 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? ❑ Yes ❑ No If Yes, provide name of company 12.PWM.0357 010434.062212 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0102798 CONFIDENTIAL SDNY_GM_00248982 EFTA01447990