EPSTEIN
page 5 / 388 . OCR, unverified
usiness name/disregarded entity name, d different from above
appropriate box for federal tax classification (require
Individual/sole proprietor 0
C Corporation 0
S Corporation 0
Partnership 0
Trust/estate
O Limited liability company. Enter the tax classification (C=C corporation, 5=5 corporation, P=partnership)
Other
El Exempt payee
MAI
110.4
Taxpayer Identification Number (TIN)
Port II
Sign
Here
Enter your TIN in the appropriate box. The TIN provided must match the name given on the -Name" line
to avoid backup withholding. For individuals, this is your social security number ISSN). For other
entities, it is your employer identification number IEIN).
Social Security Number
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). and
2. I am not subject to backup withholding because: la) I am exempt from backup withholding, or lb) I have not been notified by the Internal Revenue
Service 1IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined in the instructions).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return.
2.0 Non-U.S. Person
I am not a U.S. person (including a U.S. resident alien). I am submitting the applicable Form W8 with this form to certify my foreign status and. if applicable,
claim tax treaty benefits.
For example: Client is not a U.S. person (including a U.S. resident alien). Client agrees to provide OBSI with this application the applicable Internal Revenue
Service (IRS) Form W-8 to certify the client's foreign status. W-8 forms and instructions are available on the IRS website at www.irs.gov.
13-AWM-0198
012145.032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0104185
CONFIDENTIAL
SDNY_GM_00250369
EFTA01448974
--- SOURCE: IMAGES__0074__EFTA01448975.txt ---
METADATA_SOURCE: IMAGES0074
METADATA_FILENAME: EFTA01448975.pdf
----------------------------------------
BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (1) CLIENT HAS RECEIVED, READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS
ACCOUNT AGREEMENT. INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORMATION; AND (2) THE INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS ACCURATE.
CLIENT ACKNOWLEDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE AT SECTION III, PAGE 5, AND CLIENT
AGREES TO ITS TERMS (ALL ACCOUNT AGREEMENT SIGNATORIES MUST INITIAL',
IINfx1ALblaEl
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION
REQUIRED TO AVOID BACKUP WITHHOLDING. AND, IF APPLICABLE. THE CERTIFICATION REQUIRED TO ESTABLISH CUENT'S STATUS AS A NON-U.S.
PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING.
Important Information for ERISA employee benefit plan clients: U.S. Department of Labor regulations require DBSI to disclose to a responsible plan fiduciary
certain information in connection with the services that DBSI provides to a plan, to assist the fiduciary in evaluating the reasonableness of DBSI's services and
related compensation. The disclosure is available online, at http://www.pwm.db.comtamerkasierderisa_disclosurnAcs.html. By signing below, you acknowledge
that you aro a fiduciary responsible for the procurement of DBSI's services to the plan, you have read the disclosure and you understand the disclosure.
Individual or joint account (IF THIS IS A JOINT ACCOUNT, ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable in any relevant jurisdictions that
may arise in connection with assets, income or transactions in Client's accounts) and business relationship with DBSI.
CHECK A BOX BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
OTenants in common; or
OCommunity Property (for married couples in certain states: each spouse retains 50% interest in the community property upon death of the first spouse).
Signature
Date
Print Name
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Signature
Date
Print Name
SSN/EIN
Corporation, partnership, trust or other entity:
CONFIRMATION OF TAX AND COMPLIANCE RESPONSIBILITIES
Client acknowledges having sole responsibility to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions
that may arise in connection with assets, income or transactions in Client's accountfsl and business relationship with DBSI. Furthermore, Client confirms that the