📄 Extracted Text (497 words)
Pnit C4..;61p.ntior..irta Sleaturo
I understand that the information supplied by me in this Self-Certification (including any attachment hereto) is provided
pursuant to the Ml terms and conditions governing the Account and the Account Holder's contractual relationship with
Deutsche Bank setting out how Deutsche Bank may use and share the information supplied by me to Deutsche Bank.
I agree that Deutsche Bank may disclose this Self-Certification and any other information related to it or the Account(s)
now or in the future held with Deutsche Bank, to any relevant tax or governmental authorities of the country in which the
Account(s) is/are/will be maintained or of any country in which the Account Holder may be liable to pay taxes. I release
Deutsche Bank from any obligations of bank secrecy, confidentiality arldfOr data protection under any applicable laws
which might otherwise preclude the disclosure of such information. I acknowledge that the data protection laws of such
other countries may not afford the information the same protections which it receives In the country in which the Meetings)
is/arehvill be maintained.
I understand that this waiver will remain In force until cancelled and notwithstanding cancellation it cannot be
terminated retroactively.
I declare that the below statements are, to the best of my knowledge and belief, correct and complete:
1. I hereby certify that for the purposes of taxation the Account Holder is not a tax resident in any country other
than the country/countries Indicated In this Self-Certification.
2. I am aware that income deriving from the Account(s), as well as related transactions, may trigger a tax liability
in accordance with applicable laws and regulations and that this may be reflected in the Account Holder's
tax reporting.
3. I confirm that all assets held by the entity with Deutsche Sank Wealth Management, as well as any and all
Income and gains related thereto, where applicable, have been, and will be, taken Into account and included In
the relevant tax filings as required by the laws of the country(countries) of tax residence.
I declare that all statements made and information contained in this Self-Certification (including the information in Appendix
1 and Appendix 2, as applicable) are, to the best of my knowledge and belief, correct and complete. I undertake to advise
Deutsche Bank promptly of any change in circumstances of which I am aware of and that causes the Information contained
herein to become incorrect and to provide Deutsche Bank with a suitably updated Self-Certification within 30 days of such
change. I further certify that I am duty authorized to sign for this Account Holder and to provide all the confirmations herein
with respect to all the Account(s) to which this Self-Certification relates.
Darren Indyke
Peng Name Slonal,n
04-28-2016
Dale invneorwri
Treasurer
Capaaly
NON: Please Wale lee cogently in vorucS you are signtng Ina form
(for example Thisiett, Corporetefinettedual Director, etc)
INTERNAL. USE ONLY: Anomie Numttor(c):
WM167679 023611.041516
Page 2 of5
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0121296
CONFIDENTIAL SONY GM_00267480
EFTA01460226
ℹ️ Document Details
SHA-256
bbfd8d5c2983986b9389d874642813b7bae911871036e8f422c6794a2d8b618c
Bates Number
EFTA01460226
Dataset
DataSet-10
Document Type
document
Pages
1
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