KYC Print Page 17 of 34 One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summa 3A. Individual Details (for all parties) Individual's Name: Harry Beller - 00000487202 Date of Birth: 5/9/1956 Country of Residence: USA Country of Citizenship: USA Address of primary residence: 12 Golar Drive Monsey 10952 United States Has client resided outside of his/her O country of nationality for 5 years or more? Yes rk No Profession/Occupation: Accountant Tax ID / SSN: Current Employer: HBRK Associates, Inc Position/Title/Rank: Address of employer: 575 Lexington Avenue, 4th Roor Monsey NY United States 10022 Does the person work as senior executive of a DB-recognized regulated entity in the financial industry? (Not applicable for operating entities) D yin g No Is the individual a Politically Exposed Person (PEP)?(if Yes, describe) O Yes No To the best of your knowledge, is the individual related to an employee of the DB group7pf Family or Friendship, descnbe) O Family O Friendship gll None 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)?(if Yesdescnbe) O Yes WI No If applicable, indicate which bank officers have met the person: Indicate where and when the client meeting(s) took place: Bank Officer Name(s) Bank Office: Client Private Domicile: Client Place of Business: Other Location (specify): Date: ti O O O O 11 O O O Wealth Details for this individual are not filled in, because they are the same as for the following person: 3D. 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: O Business Owner O Salary/Eamings O Invest