EFTA01372875.pdf

7/15/2019 KYC Print One sheet must be established for EACH INDIVIDUAL PARTY In Section 2. Account Ownership Sum 3A Individual Details (for all parties) Individual's Name: Harry Beller • 00000487202 Date of Birth: 5/9/1956 Country of Residence: USA Country of Citizenship: USA Has client resided outside of Address of primary residence: 12 Gobi: Drive Monsey NY 10952 United States his/her country of nationality Li Yes Ii No for 5 years or more? Profession/Occupation: Accountant Tax ID / SSN: 081-52-0727 Current Employer: HBRK Associates, Inc Positionflitle/Rank: Address of employer: 575 Lexington Avenue, 4th Floor Monsey NY United States 10022 Does the person work as senior executive of a DB-recognized regulated entity in the financial n Industry? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities ' Yes s! X j No .... .,. U Yes kl No Is the individual a Politically Exposed Person (PEP)?(I/Ye desatbe) To the best of your knowledge, is the individual related to an employee of the DB group?(f l : Family Headship 9-. None Forney or FriendsNp, 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 source, supplier of goods or 1. Yes :11 No services)?(/Yes,descrte) If applicable, indicate which bank officers have met the person: Indicate where and when the client meeting(s) took place: Oidiets Private Client Place of Bank Officer Name(s) Bank Office: Other Location (specify): Date: Domicile: Business: l I...1 1.11 — 1.3 1- Wealth Details for this individual are not filled in, because they are the same as for the following person: 38. Wealth Details (Only for parties requinng 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: r t Business Owner Salary/Eamings Investment Inheritance/Gifts = I Other: Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. For trusts, how did settlor accumulate wealth? For inheritance, how did family accumulate wealth?For business owners, how long in business, how many employees, level of prchtability? Indicate type of business, countries of major activities, important business partners.) Estimated Annual Income(S): Estimated amount of investable assets($): Estimated Net Worth($): Amount of assets planned to invest with PWM($): Other Known Financial Institutions: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: https:ridbforcepb.my.salesforce.comiserylet/servlet.Integration?lid=01N30000000D9Di&eid=50032000015VRiO&P=18linkToken=VmpFPSKNakF4T1... 6115 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0066777 CONFIDENTIAL SDNY_GM_00212961 EFTA01372875