EFTA01460131.pdf

Entity Self-Certification Form Appendix 2: Non-US Beneficiary/Non-US Beneficial Owner Self-Certification Form Deutsche Bank AG and its affiliates (collectively, 'Deutsche Bank') collect certain information, including tax related information, from their clients. Deutsche Bank collects this information to comply with certain local and international regulatory requirements that are designed, among other things, to foster and support a tax compliant environment. Although these requirements are not necessarily imposed by all countries, Deutsche Bank, as a global bank that strives to achieve consistency in its practices among all of its regions, nonetheless requires this information be provided by clients even if not required by regulation. Accordingly, Deutsche Bank Wealth Management Americas is writing to clients and sending you this Self-Certification to complete. As a Non-US Beneficiary/Non-US Beneficial Owner of Account(s) with Deutsche Bank Wealth Management, you are required to state your residency (or residencies) for tax purposes. While Deutsche Bank Wealth Management does not provide tax advice, you may contact your Relationship Manager if you have questions concerning the Self-Certification process. If you have any questions about how to complete this Self- Certification or about how to determine your tax residency status. please contact your tax adviser or local tax authority. Entity Account Holder: please insert the Legal Name of Entity in #1 of Part 1 below and provide this Appendix 2 to each Non-US Beneficiary/Non-US Beneficial Owner, collect the completed certification and return it to your Deutsche Bank Relationship Manager. Part 1 Non•US 8eneflaary/Non•US Beneficial Owner Appendix 2 is the "Non-US Beneficiary/Non-US Beneficial Owner" Certification. This Appendix must be completed and signed by each non-US Beneficiary and non-US Beneficial Owner of the entity, regardless of whether such person is a Controlling Person disclosed in Appendix 1. The attached Guidance to the Entity Self-Certification Form provides assistance for you to determine who the non-US Beneficiaries and non-US Beneficial Owners are. Legal Name of Entity to valid] this Appendix 2 relates Non-US Beneficiery/Non-US Beneficial Owner Name Date of Birthate of Incorporation (mnddlyyyy) Part 2 Tax Residency Country/Countries of Tax Residence If you have additional countries of tax residence, please attach a list of additional countries of tax residence to this form. WA 167679 023611.041516 Page A2.1 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0 121105 CONFIDENTIAL SDNY_GM_00267289 EFTA01460131