EFTA01480826.pdf

Introduction Type Net Worth of Clint(S) Source Of Wealth / Financial Information Details Source of wealth -Identify he Clients Source of Wealth from Other followin list of o. ions ECI Party Type Party Name Last KYC Status Report Type Relation Powers Percent Completed Type Owned Search Dale Indrvxdual HARRY Fut Signer Full 00 BELLER Primary Information for HARRY BELLER Client Type Individual Generation Client Status awl Active Indicator Yos Front Office Restricted? Normal Marital Status Single Confidential Names? Country of Primary Domicile UNITED STATES Primary Domicile State PrefouTifie Insider Code (Reg 0) First Name HARRY Full Name HARRY BELLER Middle Name Gender Mile Last Name BELLER Date of Birth Suffix Primary Country of Assets Previa° sNamegAMWA liar Citizenship Employer Name High Risk Jurisdiction Occupation Industry Code (NAIC) Years at Occupation Secondary Industry Code (NAIC) Address(es) Type Notes Address Country Tools Entered by Preferred Legal Map it BATCH 06:12:2011 No Phone(s)/F. x(s) Notes Phone Number Tools Entered b Date of U ate Preferred Verily to Nol DEBRA J 08,O172012 Yes Call' Lisl GARVINE Cost Center & Hierarchy Ceent Status Client Irbdrmdual Client S • •nsor Cost Center 118313. IS/T OT CENTER Client Service Team Identification Withholding Federal Status Withholding SSN/TIN Certification Date SSNITIN/EIN Form of government issued Drivers Locense identification obtained for the Ides Primary Identification Number Issued By UNITED STATES Now York Date Issued 0599:1956 Expiration Date 05.0912019 Confidential Treatment Requested by JPM-SDNY-00003053 JPMorgan Chase CONFIDENTIAL SDNY_GM_00272251 EFTA01480826