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ails (for all parties) Individual's Name: Date of Birth: Country of Residence: USA Country of Citizenship: USA Address of primary residence: Livingston 07039 United States Has client resided of his/her on country of nationality for 5 years or more? O Yes iA No Profession/Occupation: Lawyer
fession/Occupation: Lawyer Tax ID / SSN: Current Employer: Southern Financial LLC Position/lide/Ftank: Address of employer: 575 Lexington Ave, 4th R Livingston NY United States 10022 Does the person work as senior executive of a DB-recognized regulated entity in the financial industry? (Not applicable for
dyke - 00000486405 Date of Birth: 2/19/1965 Country of Residence: USA Country of Citizenship: USA Address of primary residence: 2 Kean Court Livingston 07039 United States Has client resided outside of his/her O country of nationality for 5 years or more? Yes b1 No Profession/Occupation: Lawye
ation: Lawyer Tax ID / SSN: 098-54-8596 Current Employer: Southern Financial LLC Position/lide/Ftank: Address of employer: 575 Lexington Ave, 4th R Livingston NY United States 10022 Does the person work as senior executive of a D8-recognized regulated entity in the financial industry? (Not applicable for
dyke - 00000486405 Date of Birth: 2/19/1965 Country of Residence: USA Country of Citizenship: USA Address of primary residence: 2 Kean Court Livingston 07039 United States Has client resided outside of his/her O country of nationality for 5 years or more? Yes b1 No Profession/Occupation: Lawye
ation: Lawyer Tax ID / SSN: 098-54-8596 Current Employer: Southern Financial LLC Position/lide/Ftank: Address of employer: 575 Lexington Ave, 4th R Livingston NY United States 10022 Does the person work as senior executive of a D8-recognized regulated entity in the financial industry? (Not applicable for
Entities connected to both Livingston and 4th R Livingston