: 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 NY 10952 USA Profession/Occupation: Accountant Tax ID / SSN: 081-52-0727 Current Employer: HBRK Associates Position/Tide/Rank: Address of employ

arry Belle - 00000S Date of Birth: Country of Residence: United States Country of Citizenship: United States Address of primary residence: 12 Golar Drive Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or mere? O Yes 1.;.e..No • - Profession/Occupatio

ual's Name: Harry Beller - 00000487202 Date of Birth: Country of Residence: USA Country of Citizenship: USA Address of primary residence: 12 Golar Drive Monsey NY 10952 USA Profession/Occupation: Accountant Tax ID / SSN: Current Employer: HBRK Associates Posibon/Trbe/Rank: Address of employer: 575 Lexin

parties) Individual's Name: Harry Beller Date of Birth. Country of Residence USA Country of Ohzensh o LISA Address of primary residence' 12 Golar Drive Monsey NY 10952 United States Professor. Occupation Aomori:ant Tax D SS4 Current Empbyer: HBRK Associates. Inc Position/Title/Rank: Address of employer

rties) Individual's Name: Harry Beller Date of Birth. Country of Residence USA Country of Citizens! o LISA Address of primary residence' 12 Golar Drive Monsey NY 10952 United States Professor. OcoJpga'on Accountant Tax D SS4 Current Empbyer: HBRK Associates. Inc Position/Title/Rank: Address of employer

0000487202 Date of Birth: 5/9/1956 Country of Residence: United States Country of Citizenship: United States Address of primary residence: 12 Golar Drive Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or more? Yes 1 No Profession/Occupation: Accounta