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efta-01373042DOJ Data Set 10Other

EFTA01373042

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DOJ Data Set 10
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efta-01373042
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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: I 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 Skth Laval Agents ! Far uS. PCSGAS: • Scc& Secte4 ' Meow For tion-U.S. Persons: iSeo footnote 1 for aitenstlees to Social Seamy Nurnaer) I JEFFREY E. EPSTEIN I 1/20/63 6100 RED HOOK QUARTER, 63 ST. THOMAS, USVI 00802 I. Far Non-US. Porsond it oath:ion too Social Security tiumbor or a Passport Number with Country of Issu nce. an *lien ;dental:catkin card notes:, w numb*, and county of issuance of any other goveinmont-istoniti document evidencing notionally resilience ono thicany o photocaph of siniikr saes:lore shoula be oroviOetl. no individual moats this del:ninon. *inst.write 'Not apOcatiteil 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 Name Date of &In JEFFREY E. EPSTEIN SEE Leytil Address I ABOVE For US. Parsons: I For Non-U.S.Pt:mon Social Security (Sea kw note anenatiuesi lawOhet I to Social Senixity Number; Ec • Nuti•US. Persons. In sooakin to a Social Security Wont*, 04, e Passport Maltby anIn Country of Issuance, an atan itientifical ion card narrate. pi nuniiha 3f1O country of issuance of any ether gestrnmentossueddocummit OVillenCilic; nationalityo residence and nestind s ohotocaoh of sininar raferaiacti shou osi ohs/ten. (name of natural person opening the account), hereby cern 'nest of reektecrabome is complete and correct. Signature Veri 7/24/18 Date fagot Entity Identifier (Optician Warne (Pont): Title CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0067032 SDNY_GM_00213216 EFTA01373042

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