Entity Self-Certification Form

Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must be completed for each Controlling Person of the entity, but only if the entity has a tax residence outside the United States. Please refer to the attached Guidance to the Entity Self-Certification Form which provides assistance for you to determine the Controlling Persons and how to complete this Appendix. Please provide details of each Conholing Person below. PleaSe Continue on a separate sheet if necessary (and attach to this form). Piro Name Rich Dale d Country/Canton ex enodenn US Is Controlling Person a non-US Senefictaryinon-US Seminal Owner, Firm Nairn Jeffrey Dale of CoontrOCcomfiet of In R•Sideoge US Virgin Islands • Is Contolling Penn a non-US Eleneficiarylnon-US Itenetoal Canon Finn Name Erika Dale PS County/Countries of Tax Renitence US Virgin Islands Is Controlling Person a non-US ElonelinasynotUS Elenefnal Chimer? Pint Name Darren Dale of Si Countrp s o. tax to64.,C.0 US Is Cpuroling Persona non-US Senoteery/non-US Beneficial Damn rem Name Dab of Son Country/Counisies of Tax ReSAlenCe tat Nara Kahn Conirosina Pence Wm", President Yes (COMIntaAPDellik 2i J No lam Nora Epstein Cm/I.:ding Pwrim' TSPRIRat" Director Yet (complete Appendix 2) V No Lag ft. " Kellerhals Controlling Panora rt,Pefftere Secretary, Director Yes (COWIN, boon* 21 tn Last la" Indyke caucano Pi sa" lI aCats Treasurer, Director Yes (complete Appendix 2) Mo Is Controlling Person a non.US Yes (Ca pima A3penth% ehnigesarYMOO-USINMOStial Orme° LOS Name Conning Penn ;tango* Each Controlling Person who Is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2: Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely in the United States is not required to complete and sign Appendix 2. wm167679 02%i / 0XISIG Pepe Al CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0031374 SDNY_GM_00177558 CONFIDENTIAL EFTA01345182