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efta-01379560DOJ Data Set 10OtherEFTA01379560
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DOJ Data Set 10
Reference
efta-01379560
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II. Certification of beneficial owner(s)
Persons opening an account on beha€f of a legal entity must provide the following information:
a. Hanle and Tide of Naturro Pelson Opening Account:
Z-eQR-.N
(7.c4,et,...) b. Nhh35 of Legal Entity. Type of Legal Entity.
Address of Legal rfintity f it,Nifech trta Arzucint
€3:4;(1.3 .05y44.0d:
S.1o_ lIt~4w4tti - tJc,P .kn •A+e~G-LC..) C.Nezt osb
C .1•7 unk:14/..
1
COI 4n0 ieeC9 keZIOkai
0
Vt
i2br i 63
LDS t 042,13 (.7-i.
f;,.,, `:.,y ;rijorniat;)r, ;-(); .?.3Ch glr;V.
drretiti'i OF inekectly. through ;sny contrT:t arrangement understanoing, relhf:onh:p Or Other:NIS% owns 25 percent ni mole of the agility interest; of tne legal entity listed above:
!ILI!' !V:.JI:4 ^•••.[,13 'Ur-a C wean (1›:)(s--3 61 co ea 415.2V (2k,..A-cri q3 usvc (>08 u
'z;r tlå heisona:
F. umber Fix rem.4.1.:s (An3y..e r9freinotr4.3311. ic, .1*ern3t1,:te
to Scelai Sechnh Svniterj - Aar :•;c,3•11:3.5yraent.
soeeticyn 3,3 Owed Ser.krrity `,hinter ol n Nar..xet evn.e.a.ileiir.:cuicce Of •mwarcrs rei oars, kyint - rtim :74;'% ,",•;n;b0.
1-galgir ,tred ANoit y iiT.Wmtli M ner tenor aineron3.3.hsenclOcrewhent rnelryd:inD roponality ur reednnta an'sbaffling a phoh.grapri rx samtev 33/3eirahl 33 halt'
er.yridr .
ne
nines ibis definhxg!. ga.å9Iltsriie ";e!:3?;3,table
O. The following information hir one Ihri1ViCP31 with significant responsibility tor managing the legal entity listed above,
such aa:
• An re33COtiVT3 officer or :rainier manager
Chief Executive Officer. Chief Financial Officer. Chief Operating Officer,
Managing Member, General Partner, President Vice: President. Treasurer): or
• Any Other iwiividual who re,guiarly perfmina Sitreit: ihettiCK,S.
(If appropriate, an intfividual fisted uncle' section (c) above may atsn be listed in rhia section (d)).
t33,r3, 3.-St-tet 6f'k",
FOr >144,4331. keor,r3t... rg.irkt >:vatre..,
NPtii•Writ i3vard>3.
,,3r, car, rsobs
MbeirettnIre et WW/1111» Of nay Ottlid gown, men Haan CIDC3i(heel tirlerll}rgnknonalhk el tether c.e ant: n
t; p I pree.33,3re nå yrntlarinfitoren thceln Dift,PC.f ; f(y"jitdOtta:1
'1).) A1.0 Ptrhue:
Rurote.:<
IU
I.S9efnitl~.{fm MietThr!:V..N.
tincial SL:Ul
NU!~
£4
ily• '1edge. tftt the in 44e03,Sie ktenteinr re.5.,, tang)
(name of natural person opening toa account), hereby cattify, tO th,,,trest of
emplate rand Ø) rett.
O aota OeuZerie %et AO. All fleets reternre. WM199866 O..??al Oil:51019
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0077153
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