EFTA01583341.pdf

kpr-I8-2013 09.0e itienreen Chase 0Z-634.5580 Special Consideration Form J.P.Morgan Inaltuttians: For Consumer and Business Card, fax completed tam and accirc.aton to 1877.676.2626. For Consumer/Business Canis for all Latin funerican Clients, please email the completed form and application to listrbution list: 'Specie) SerMoss Section 1: Line of Business: (select one) BI J.P. Morgan Private Bank 0 J.P, Morgan Mete Wealth Management 0 Chase Private Client ❑ J.P. Morgan Securities 0 J.P. Morgan Law Finn Program Section 2: Type of Inquiry (check one ear each section below) Al Domestic 0 International RI I:Consumer Business IE Now Application 0 Reconsideration 0 Credit Limit increase (Account 0 (",:rettit Reepested 5 550,000 Section 3: Banker Information: (outlets% all fields) Today's Date: 03/2812013 lieqJestor Janet E. Young &Mar Address: Phone NUmber: Standard ID Section 4: Applicant I nfotelation; (complete as relevant fields) CAS ID Name otAppercent Authorizing Officer: Jeffrey 4steln Business Name: Southern Trust Company, Inc Soca' Securty Number or I ilk Tax ideriMicabon Nombre (TIN) _ USA Patriot Act (LISAP) ir no dostid Snub* Mamas or MK Chase Card Eiseidop• is isigaindl to calm, teen follcsaars 0OrtIVIII 'Identification Type eo P;OWL SEWN idannfkittnn Cut, Ce staintaa1Giassnarient Sued dtnte • Identification Number: ' Country Issued By ' issued Day: • Expiration Date: Appileant's/Company's physical address Of different on the istplciniont Present Employer. Epstein interests • self employed Occupation /Postilion: Investor i Advisor Time with Present Employer. 25 yrs. moths 'Gross Annual Income: S 101200•001 00 Business Inoome $ ••Alonorry, chid sospart• ca sopa note tgaiiitinenta need teal Do inclutlad a you 40 not viiittio oats on 1. Gees lent* imam aincome/1M you are abls ma for repaytrog year yew. Eaknplis rosy nude r'wnw ant tem Wanes. lavainnwsida wide ropintio,sooel SeCtnitf berths at n. N4blij t aetounts Net Worth (eicketne Minty Raisiecescar. $ 150,300,000.00 Investable Assets; Section 6: Depository(lnveslment Relationship Information: Iwo -ode 44 awl,klkormfOr; so pwisiait - un adMoial snots it meow! Account Number Typo Balance Open Date Financia€ Trust Co.. inc. Asset w/ brokerage itati79,eso.00 0310/2010 Inc Asset wibrokerast $t3,743,878.00 081612002 Southern Trust Co Inc. Checking $8,591,531.00 02111/2013 * txtraks ainaanid Said Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00062989 EFTA01583341