EFTA01372810.pdf

7 5 2019 1\YCi Punt One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownersh Su ama r 3A. Individual Details (for all part es) Individual's Name: Erika Kellerhals-- Date of Birth: Country of Residence: Virgin Islands, U.S. Country of Citizenship: United States Has client resided outside of his/her country of nationality Yes ,° No Address of primary residence: for 5 years or more? Profession/Occupation: Attorney Tax ID / SSN: Current Employer: Kellerhals Ferguson Kroblin PLLC Position/Title/Rank: Attorney Address of employer: 9100 Port of Sale Mall, Ste 15 St. Thomas Virgin Islands, U.S. 00802 Does the person work as senior executive of a 0B-recognized regulated entity in the financial ndustry? or an entity listed on a DB-recognised exchange? (Not applicable for operating entities • Yes '''' No Is the individual a Politically Exposed Person (PEP)?(ff Yes, describe) N/A Yes It No To the best of your knowledge, is the individual related to an employee of the DB group?(// : Family : Fnendship II. None Familyor Mends/WA describe) N/A 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 services)? Yes (if Ya,desaibe) N/A Indicate where and when the client meeting(s) took place: If applicable, indicate which bank officers have met the person: Client Private Client Placed Bank Officer Name(s) Bank Office: Other Location (specify): Date: Domicile: Business: 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 ki Seddon 2) Nature of the Indrvidualts Business: Primary Country of source of wealth/source af Funds? Primary industry d source of Wealth/Source of Funds? Summarize Source of Wealth: Business Owner Salary/Earnings ):)... Investment 1...i Inheritance/Gfts Other: Further Describe Source of Wealth /Detail the history of wealth for each of the sources: (e.g. Pa Mists, how did settler accumulate wealth? For inhentance, 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(;): Estimated Net Worth(f): Amount of assets planned to invest with PWM(S): Other Known Financial Institutions: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: Institution: Country: Est. Assets Under Mgt: https://dblorcepb.my.salesforce.comiserviet/servletintegration?lid=01N3000000009Dkaeid=5000e00001N08xm&ic= I SiiinkToken=Vmpf PSxNakF4 • 14/42 CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0066692 CONFIDENTIAL SDNY GM_00212876 EFTA01372810