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IL Certification of beneficial owner(s)

DOJ EFTA Data Set 10 document EFTA01298375

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DOJ EFTA Data Set 10 document EFTA01298375

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EFTA Disclosure
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IL 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: J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC., A 501(cX3) PRIVATE FOUNDATION/USVI CORPORATION 6100 RED HOOK QUARTER, 83 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: None I Data of Seth Legal Address rFor !LS. Persons: , Social Secutity I Number Fe Mon.U.S. Persona: (See loot0ft i tor alternati. to Soda! Satiny Number) i NOT APPLICABLE I I I I I I i i I ' For Non-US. Persons. In ode Wact to a Social Security Nutmeat ore Pateprxt Iltatiftr wrtn Country of Issuance. et alier. t000rilleation we narrow. Di owned/ ono country Di ;nuance of any eine government-10mM document evidencing nationality or residence and bearing a olvtograpn a simile safeguard stral be provided. (Ii no kb:lin:kat meets this dot inition. ukase write "Not AnoticablOn cl. 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)). Nam* JEFFREY E. EPSTEIN ! Fa Non-US, Parsorc, in addition to a Social Scatrey Numuc: to a Passport Number t0l. Country of issuance. an Aticti Wt.:nits:anon card number- or number ann country o1 itrurnyto of any otne: gore nment-issued document eviciencIns nationakynr resrctmee and bearing a c?rotogrann at sinter Seenuard rokluit be provided. Date of Sire, 1/20/53 Legal Az.o. toss 6100 RED HOOK QUARTER, 83 ST. THOMAS, USVI 00802 Foi U.S. Pylons: I For Non.U.S. Persons: Social Set.utity I (See foomoza for altenarivar Number ! to Social seamy Nuarder) EFFREY E. EP EIN knowledge, that t le info Legal Entity Idenolnir (00001) gn Date me of natural person opening the account). hereby certify, to the best 01 is complete and correct. Signalur 7/24/18 SrplfAtt 04-( Na nnl):a Dale: SDNY_GM_00062720 CONFIDENTIAL - PURSUANT TO FED. R.QPN(F 1DENT1AL DB-SDNY-0025545 EFTA_00 173228 EFTA01298375

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