) in connection with Client's business relationship with OBSI. Name ol Entity R rote- MA I_ cif Employer ID Not Date 11 Signature of Officer, Partner, Tnntee, Auiltorized PIM Print Memel-I itte_Alitt 11Pri g..413%) ) • ..A;th I), Signature of Officer. Partner. Trustee. zed Party 1............)0 ...