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COMPLAINT FORM Public Communications Unit, Bank of Israel, Banking Regulation Tel: 1212-200680 Fax: 02-6669077 Submitted as an attachment

to the online Complaint form, and by fax.

Signing, Certification - no changes allowed; Digitally signed by Joseph Zernik, PhD Location: Jerusalem Date: 2012.08.25 05:22:31 +0300

URGENT: Action by Bank HaPoalim against my account may be initiated on September 1, 2012. 1. 2. 3. 4. 5. 6. Customer Name: Contact Information: Email: Financial Institution, subject of the Complaint: Bank Code: Branch Number: Dr Joseph Zernik PO Box 31440, Jerusalem 91313 123456xyz@gmail.com Bank Hapoalim, LTD 12 694

7. Details of the Complaint: I am a German, Israeli, and US citizen. In April 2010, I came to Israel after many years in the United States. By 2011, I established my residency in Israel and opened my account with Bank HaPoalim. I signed the agreement as a resident of the State of Israel, under my Israeli Tax/ID number. To the best of my recollection, the customer agreement, which I signed at that time was in Hebrew, with an Israeli banking institution, name Bank HaPoalim, LTD. Over the past 2 years, I hardly visited the bank and hardly made any transactions beyond periodic cash withdrawals. On Thursday, August 23, 2012, I visited my branch, and met with a representative from the Private Banking Department. The representative presented for my signature (attached): a) Bank HaPoalim, LTD, papers, including an unsigned demand letter by Bank HaPoalim, LTD, and papers titled "US Person Undertaking and Waiver," (in both Hebrew and English) and b) US IRS Form W-9. The paper in a) above, includes, but is not limited to requirements that I "pay any US federal income tax due with respect to income derived from all accounts", which I hold or will hold with the Bank, and "provide the Bank, upon request, with copies of the applicable Schedule B of IRS Form 1040 ("Individual Income Tax Return"). I protested, and asked under what law I was asked to sign such papers. The representative answered that it was pursuant to some international treaty. Eventually, the Branch Assistant Manager was consulted, and it was agreed that the request was made under US law the Foreign Account Tax Compliance Act (FATCA ). I again protested, saying that as a resident of Jerusalem, banking with an Israeli bank, I was not subject to US jurisdiction. The Assistant Manager explained that Bank HaPoalim, LTD, was a US corporation, and it therefore devised its own procedures in order to comply with US law. I again protested that it was unlawful conduct by the bank. The Branch staff advised me that if I did not sign the papers, my account would be frozen, and I may not have access to my own funds. However, they remained unclear regarding the date by which such action would take place September 1, 2012, or January 1, 2013.

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August 25, 2012

8. Actions taken so far towards resolving the issue: Following advice by the Private Banking Branch staff, we did the following: a. I immediately issued a request to release some cash, to be executed on August 26, in case my account is blocked on September 1, 2012. b. I left a written letter to the Bank management with my Private Banking representative, asking whether my account will indeed be frozen, either on September 1, 2012, or January 1, 2013. 9. Are there any legal procedures in process in this matter before any other agency: None 10. Any specific request: I request that the Banking Regulation Unit of Israel Bank would urgently: a. Protect me against unlawful actions by Bank HaPoalim, LTD, against my account, and ensure that I am provided full access to my lawful property funds deposited in Bank HaPoalim in accounts under my name. b. Protect me against threats by Bank HaPoalim, LTD, to unlawfully block or effectively seize my funds. Jerusalem, August 25, 2012 __________________ Joseph Zernik, PhD

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