EFTA01282927.pdf

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DBTCA Deposit Account Opening Application
Private Wealth PremiumiM Private Wealth Premium "4 Private Wealth Premium TM
Elite Personal Accounts Elite Business Accounts Banking Services
D Checking Acct. a q Consumer Debit Card I
• Elite Checking with Interest O i e ecing wi 1 nterest O Joint Applicant Debit Card s
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APY APY O Business Debit Card N
O Elite Money Market Deposit Elite M
Acct. II Acct. N M IK 12(Deltice CtrZOOk Style #
APY APY (0 417- ff
O Certificate of Deposit O Certificate of Deposit O N)ame Only
Acct. 8 Acct. N s" Name and Address
APY APY
Term Term O Duplicate Statement
O DB AG NY Preferred O DB AG NY Preferred Add(
Certificate of Deposit Certificate of Deposit City
Acct. ff Acct. I State Zip Coda
APY APY O Mailing address (if different)
Term Term Name
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along wig,. OB AG Preferred Terms along with a 08 AG Preferred Terms City.
and Conditions) and Conditional State Zip Code
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Private Wealth Premium Cash Master Sweep Account
Internet Banking Services Checking Acct. If
Ca/ DB Private Wealth Online Plus Elite Money Market Deposit
Link to Existing Online Relationship Acct.
APY
Target Amount
Trigger Amount
Client Relationship
q Individual Account q Custody under NY UTMA O Corporation
O Joint Tenants with Right O Foundation I 3 Limited Liability Company
of Survivorship
O Joint Tenants in Common O Non-Profit Organization O Partnership
O j In Trust For/Payable on q Attorney Trust Escrow O Limited Liability Partnership
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13.AWM-0101
NAOSOD00015602-000104611
013959437613
SDNY_GM_00038526
CONFIDENTIAL
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0001350
EFTA_00149135
EFTA01282927

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X3UCIi; and tp rriAppljcatipormation .0-ro Wev/2007
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Name of Account ?lo / Joint Applicant
pa rsYMss (lest name, first name, middle initial)
Societ Stzuristz Na.?erArlict payizr1O5hiu*ribAn Social Security Number or Taxpayer ID Number
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Address Address
_pa t. id Q A I I (/— Not applicable
City, State anti Zip Code Coty . State and Zip Code
H ome Telephone Number
SOS mess Telephone Number
Date of Birth Date of Birth
Nemec, Employer Name of Employer
Address Address
Not applicable
City. State and Zip Code Cm, State and r' Code
Notice of Customer Identification Policy
Important Information
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial
institutions to obtain, verify, and record information that identifies each person who establishes an account, investment or
other business relationship with a financial institution. This means that we will ask for your name, address, and other
information that will allow us to identify you. We may also ask to see identifying documents such as a certificate of
formation or good standing (legal entities) or a passport or other photo identification (individuals).
3rd EU Notice
Governmental rules have also broadened the scope of the Bank's obligations to aid in the fight against money laundering
and terrorist financing; these rules call for an active involvement of both asset management firms and their clients. For
new and existing clients we currently have a legal obligation to ask our customers questions regarding their identities.
addresses, source of funds and, if necessary, legal representatives, outbound signatories. beneficial owners or control
structures and to collect requisite documentation to substantiate the information. Also, enhanced anti-money laundering
requirements require that should any of the above personal or institutional information change, our clients would be
obliged to immediately notify us of the change(s) and provide us with relevant documentation to verify these changes.
Telephone, Facsimile or Email Instructions
By signing below, you agree that from time to time you may grve instructions by telephone, facsimile or email regarding
the above captioned accoundsl (defined herein as "Verbal Instructions"). It is understood that the risk of Verbal
Instructions being given by person or persons purported to be you is your own. Absent the gross negligence or willful
misconduct of °Mucha Bank Trust Company Americas (DBTCA), you agree to indemnify and hold harmless DBTCA for
any claims, losses, expenses, costs or attorneys' fees resulting from OBTCA's acting upon such misunderstood and
unauthorized Verbal Instructions. You understand that DBTCA may. but shall not be required to. seek verification of your
verbal, facsimile or email instructions by call back In case of doubt. DBTCA may in its sob discretion refuse to execute
your Verbal Instructions or any part thereof, without incurring any liability. DBTCA is wider no oblication tb execute your
Verbal Instructions to transfer funds or securities to any account(s1 without written instructions bearing your original
signature.
Joint Account Disclosure
You have opened a joint account with DBTCA and acknowledge receipt of the following information: This deposit and any
additions to the account shell become the property of each owner as joint tenants, and DBTCA may felease the entire
account to any owner during the lifetime of all owners. DBTCA may honor checks, orders or withdrawal requests from
any owner during the lifetime of all owners. The Bank may be required by sennce of legal process to remit funds held in
the joint account to satisfy a judgment entered against, or other valid debt incurred by. any owner of the account. DBTCA
may honor checks, orders or withdrawal requests from the survivodsl after the death of any owns*, end may treat the
account as the sole property of the survivors) after the death of any owner(s). Unless DBTCA receives written notice
signed by any owner not to pay or deliver any joint deposit or addition or accrual. OBICA shall ndt be liable to any owner
for continuing to honor checks, orders or withdrawal requests from any owner. After the receipt of the notice referred to
in the previous sentence. DBTCA may require the written authorization of any or all joint owners for any further payments
or deliveries.
2 1SAWileiCit
013959.037613
SDNY_GM_00038527
CONFIDENTIAL
CONFIDENTIAL - PURSUANT TO FED R. CRIM. P. 6(e) DB-SDNY-0001351
EFTA_00I49I36
EFTA01282928

ATM/Debit Service
You agree that the retention or use of the ATMFDebit card constitutes acceptance of the terms and conditions of the
Cardholder Agreement contained in the Terms and Conditions of Deposit Accounts.
Internet Banking Service
If you have selected to receive Internet Banking Services, you understand that you will be required to enter into a
separate Internet Banking Services Agreement with DBTCA before you can access the IntelInel Banking Service.
Acknowledgement of Receipt of Privacy Notice
By signing below, you acknowledge receipt of DBTCA's Privacy Notice included in the Application Package.
Non-US Individuals: Confirmation of Tax and Compliance Responsibilities.
You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable
to you in any relevant jurisdictions that may arise in connection with assets, income or transactions in your account(s)
and your business relationship with DBTCA.
Non-US Organizations: Confirmation of Tax and Compliance Responsibilities.
You confirm that it is your responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable
to it in any relevant jurisdictions that may arise in connection with assets, income or transactions in your account(s) and
your business relationship with DBTCA. Furthermore, you confirm that the necessary information (to the best of your
knowledge and capabilities) is made available no less than annually to the relevant beneficial owner(s), senlor(s).
beneficiary(fes), panner(s), etc. to enable him/hed them to fulfill any respective tax obligations Mat may arise for hirrilherf
them in connection with your business relationship with DBTCA.
Please complete and attach separate W-8 or W-9 documentation as applicable.
Terms and Conditions and Representations
By signing below, you acknowledge receipt of the Terms and Conditions for Deposit Accounts attached to this
Application and agree to be bound by them. In addition, you agree to notify us immediately of any material change to
the information provided by you on this Application.
You represent and warrant that all of the information provided by you on this Application is accurate.
The Terms and Conditions for Deposit Accounts are subject to change.
Acceptance
You understand that this appecation is subject to acceptance by MICA
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3 13.AW9.1.0101
013959032813
SDNY_GM_00038528
CONFIDENTIAL
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0001352
EFTA_00149137
EFTA01282929