EFTA01372863.pdf

715:2019 KYC Print One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details (for all partes) Indrvduars Name: Harry Beller Date of Birth: Country of Residence: USA Country of Citizenship: USA Has client resided outside of his/her country of nationality for Yes I No Address of primary residence: 5 years or more> Profession/Occupation: Accountant Tax ID / SSN: Current Employer: HBRK Associates, Inc Position:Title:Rank Address of employer: 575 Lexington Avenue, 4th Floor Monsey NY USA 10022 Does the person work as senior executive of a DB•recognized regulated entity in the financial Yes I No ndustry' or an entity listed on a DB-recognised exchange? (Not applicable for operating enbties , Yes I. No Is the individual a Politically Exposed Person (PEP)?(K Ye; desaibe) To the best of your knowledge, is the individual related to an employee of the DB grouP7(1FOCI* . Family . Fnendship .1 None cr Friendship, dente) 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 servrcesp(f Yes Yegdessiber) Indlate where and when the client meeting(s) took place: If applicable, indicate which bank officers have met the person: Client Private ° to Place of Bank Officer Name(s) Bank Office: Other Location (specify): Date: Domicile: Business: 0 Wealth Details for this individual are not filled in, because they are the same as for the following person: 3B. 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: i. • Business Owner Salary/Earnings Investment Inheritance/Gifts Other: Further Describe Source of Wealth /Detail the history of wealth fo each of the sources: (e.g. For truss, how did settlor 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($): Estimated amount of Investable assets(S): Estimated Net Worth($): Amount of assets planned to invest with PWM($): Other Known Financial Institubons: Institution: Country: Est. Assets Under Mgt: Institution: County: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: https://dbforcepb.my.salestorce.comiseNlet,servlet Integration7Id=01N30000000D9Di&eid=50060000001aNty&ic=1&linkTokensVmpFPSxNakF4T1... 18125 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0066764 CONFIDENTIAL SDNY GM_00212948 EFTA01372863