EFTA01582808

Is this DDR being used for multiple entities? r Yes 6 No Last Name: First Name: Middle Name/Initial: Previous Last Name(s): Title: Business Name: (To Record Individual's Ownership Or Employer) it Primary Addresses Address (Legal address on account) Business Address (Other than Primary Address) Name: Ms. Attention: Address Line 1: Address Line 2: City: State: Province: Postal/Zip Code: Country: UNITED STATES Legal Entity: Individual / Joint Industry Code: NAIC Code: Citizenship: To be confirmed Date of Birth: (Use 4-digit year) Gender: Female Tax ID # : Remember to collect W-8's or other applicable tax forms for each jurisdiction. Passport/Drivers License #: Home Phone: (212)-000-0000 Introduction Information Introduction Type: Related Client NC Specific Information: Jeffrey Epstein Met With Principal? r Yes (3 No If you did not meet the Principal, give an indication of why you haven't met the individual and when you will. Mary will meet with her as soon as possible. She has met several times with Jeffrey Epstein. What form of goverment issued identification document did you obtain for the files? Other If Other ,Please Describe: not yet supplied Financial Information Occupation, Business or Employer of the Client: Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00062381 EFTA01582808