EFTA01460180.pdf

Part n TaA residency Please complete this section with the relevant information for each country in which you are tax resident. If you have additional countries of tax residence (i.e. if you need more rows than those given in the table provided), please attach a statement to this form containing the required information. Field Guidance Country/Countries of Tax Residence Enter the full name of the country in which you are resident (or the entity is resident) for tax purposes. If you are tax resident in more than one country, please include full names of the other countries in the subsequent rows of this table. Declaration and signature Please read statements 1-3 in the applicable section (individual or entity) and confirm that the statements are, to the best of your knowledge and belief, correct and complete. Then please read the declaration and complete the signature section. Signor must be authorized to sign on behalf of the entity and must indicate the capacity in which he or she is signing the form (e.g. Trustee, Corporate/Individual Director. etc.). O 2016 Deutsche Bank AG. All rights reserved. WM167720 023743.041516 CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0121224 CONFIDENTIAL SDNY_GM_00267408 EFTA01460180