Bankbox - Private Client MASTERDATA.

Dear Customer, To follow diverse legal requirements but also to optimize our business relationship and avoid future questions we kindly ask you to complete this form. Thank you very much for your understanding and your patience.

Name

Address

Country/Nationality

FATF GAFI Area FATF GAFI Area Yes No

Email Address

Web site

Contact name

Beneficiary

Box Size (please select one) Box Size (please select one) Small Box rental (625 DK/ 6 months) Medium box rental (1.000 DK/ 6 months) Big box rental (1250 DK/ 6 months)

* Initial fee including box card 250 DK (even price) *

(In case of beneficiary/ies please attach Power of Attorney detailing the Terms & Privileges for beneficiaries)

Standing Instructions

Account holder

Beneficial owner of the account

Account number

Bank name

Bank address/Country

BIC / SWIFT

CLEARING / ABA

IBAN

I confirm having given the correct information to be registered and stored at Sequoyah Wealth Management.

Place and Date

Legal signature

Name / function

Attached documentation*: Copy of personal ID – cards beneficial owner, authorized employees for e.g. trading, deliveries, etc. Copy of Proof of Address - or comparable information (private) Power of Attorney (for beneficiaries)