📄 Extracted Text (391 words)
KYC Print Page 17 of 34
One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summa
3A. Individual Details (for all parties)
Individual's Name: Harry Beller Date of Birth:
Country of Residence: USA Country of Citizenship: USA
Has client resided
outside of his/her
Address of primary
country of nationality for O yes iA No
residence:
5 years or more?
Profession/Occupation: Accountant Tax ID / SSN:
Current Employer: HBRK Associates, Inc Position/Tide/Rank:
Address of employer: 575 Lexington Avenue, 4th Roor Monsey NY United States 10022
Does the person work as senior executive of a DB-recognized regulated entity D yin g No
in the financial industry? (Not applicable for operating entities)
Is the individual a Politically Exposed Person (PEP)?(if Yes, describe) O Yes No
To the best of your knowledge, is the individual related to an employee of the O Family O Friendship gll None
DB group7(if Family or Friendship, descnbe)
To the best of your knowledge, is the individual party to a non-banking
relationship with Deutsche Bank (e.g., external legal counsel, client referral O Yes WI No
source, supplier of goods or services)?(if Ye4descnbe)
If applicable, indicate which bank officers have met Indicate where and when the client meeting(s) took place:
the person:
Client
client Place
Bank Officer Name(s) Bank Office: Private Other Location (specify): Date:
of Business:
Domicile:
ti O O
O O
'1 O O
O Wealth Details for this individual are not filled in, because they are the same as for the following person:
3D. Wealth Details (Only for parties requiring source of wealth description as indicated in Section 2)
Nature of the Individual's Business:
Primary Country of source of wealth/source of
Funds?
Primary industry of source of Wealth/Source of
Funds?
Summarize Source of Wealth:
O Business Owner O Salary/Eamings O Investment II Inheritance/Gifts
11 Other:
Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did senior accumulate
wealth? For inheritance, how did family accumulate wealth?For business owners, how long in business, how many employees, level
of profitability? Indicate type of business, countries of major activities, important business partners.)
Estimated Annual Income
Estimated amount of investable assets(g):
(S):
Estimated Net Worth(;): Amount of assets planned to invest with PWM(1,):
https://dbforcepb.my.salesforce.com/servlet/senflet.Integration?lid=01N30000000D9Di... 8/2/2018
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031455
CONFIDENTIAL SDNY_GM_00177639
EFTA01345235
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EFTA01345235
Dataset
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