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efta-01370745DOJ Data Set 10Other

EFTA01370745

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DOJ Data Set 10
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efta-01370745
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a. Name and Title of Natural Person Opening Account. JEFFREY E. EPSTEIN, PRESIDENT b. Name of Legal Entity. Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: MORT, INC., A USVI CORPORATION 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name i-- Date of Etkth Legal Annan For U.S. Persons: Social Security Number For Non-U.S. Persons: ! iSco footnote 1 for aiterastlasi to Social Seamy Nurnoer) I JEFFREY E. EPSTEIN I 1/20/63 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 I I I I I ' Far Non-U.S. Persona in oath:ion too Social Security tiumbac a Passport Number with Country of Issu nct. anent, identirisettrin caw notes:, or numb*, and county of issuance of any other govainment-istoniti document evidencing notionally or resicence anti thicento o photocaph or siniikr ssfesuere shoula be ocoviOetl. (If no individual meets this clef:ninon. *inst. write 'Not ao0catite.") d. The following information for one individual with significant responsibility for managing the legal entity listed above. such as; • An executive officer or senior manager (e.g., Chief Executive Officer. Chief Financial Officer. Chief Operating Officer. Managing Member, General Partner, President, Vice President, Treasurer); or • Any other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). I Dated aidn JEFFREY E. EPSTEIN SEE Leytil Address I ABOVE For us Parsons: I For Non-U.S. Ocoonn Social Security (See foot note for anernativail fatentic I to Social Senixity Number; Fc • Nuti.US. Persons. In sooit:on to a Social Security Water 04, e Passport Mantic into Country of Issuance, en atan identification card narrate. oi nuniiha 3,10 country of issuance of any other genunmontossued document evidencing nationality o residence ant":a:,r,^0a onotocaoh or sinner saferaierti shoo orovioon. fagot Entity Identifier (Optician (name of natural person opening the account), hereby certi hmst of rovfdactabate is complete and correct. Signature Veri 7/24/18 Crate S trAttme-f Warne (Pont): Title rosy._ CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0063756 SDNY_GM_00209940 EFTA01370745

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