Pictet & Cie "form A" declaring Mike Quiel as beneficial owner
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Transcript of Pictet & Cie "form A" declaring Mike Quiel as beneficial owner
EXHIBIT 9
Case 2:11-cr-02385-JAT Document 180-9 Filed 02/05/13 Page 1 of 2
A Account No. : Contracting partner:
l'y~~Hq~AG
ß,.~ .(j PO t?tW q8f'1I
Establishment of the Beneficial Owner's Ide(Form A as per art. 3 and 4 CDB)
The contracting partner hereby declares:(mark with a cross where appropriate)
o that the contracting partner is the sale benefic
if that the beneficial owner/s of the assets i
Full name (or Company), Date of Birth, Nationalit ,
es to inform the bank, of his own accord, about any changes.
Wilfully entering faof documents; under p
ten in this form is a criminal offense (art. 251 of the Swiss Penal Code, forgeryf penal servitude of up to five years or a prison sentence).
Place and date
GE/~Dimitri000089
Case 2:11-cr-02385-JAT Document 180-9 Filed 02/05/13 Page 2 of 2