ntant Tax ID / SSN: Current Employer: HBRK Associates, Inc Posibon/litle/Rank: Accountant Address of employer: 575 Lexington Avenue, 4th floor Monsey NY United States 10022 Does the person work as senior executive of a DB-recognized regulated entity In the financial industry? or an entity listed on

ry Beller - 00000487202 Date of Birth: Country of Residence: United States Country of Citizenship: United States Address of primary residence: Monsey NY 10952 United States Has client resided outside of his/her country of nationality for 5 years or more? Li Yes g No Profession/Occupation: Accoun