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Deutsche Bank
Wealth Management
k..
Entity Self-Certification Form
Purpose of this 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' ealth Management Americas is writing to ctients and
sending you this Self-Certification to complete.
This form is to be used in any situation whtIO the Account Holder is en entity. and not an Individual, If in fact the Account
Holder is an individual, the individual should complete and provide the Individual Seif-Certification Form which you can
obtain by contacting your Deutsche Bank Wealth Management Americas Relationship Manager.
Please note that a branch of an entity is treated as the entity for purposes of this Stif-Certification and. therefore, the form
should be completed with details for the branch, and not the details of its parent.
Please complete all sections below as directed and provide any additional information as may be required. For the
purposes of this Self-Certification. "Account(s)- includes any accounts currently held with Deutsche Bank by the entity.
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 turn
or about how to determine your tax residency status, please refer to the attached Guidance to the Entity Serf-Certification
Form, or contact your tax adviser or local tax authority
The 2007 Jeffrey E. Epstein insurance Trust 113
Legal Warne of Entity
US Virgin Islands
Country of locavoratto or Cliganctaton
Entity's Country (Countries) of Tax Residence
US Virgin Islands
If Entity Account Holder is tax resident only in the United States, please proceed directly to Appendix 2 (which
must be completed by each non-US Beneficiary and each non-US Beneficial Owner). If Entity Account Holder Is
tax resident outside the United States, please proceed to Part 2 and complete Appendix 1 and Appendix 2.
Please insert the Legal Name of the Entity in Part 1 of Appendix 2.
Page I of S
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0043401
CONFIDENTIAL SONY GM_00189585
EFTA01357086
ℹ️ Document Details
SHA-256
eba6ae16d641adbd04a4ca5cec1c9f558b11da9aa35f148311e4bfb0b27bfddf
Bates Number
EFTA01357086
Dataset
DataSet-10
Type
document
Pages
1
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