EFTA Document EFTA01357087

si No coy:omit littwn lvFollwe Beneficiary Yes (sabres Appendix 2) 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-Codification Form which provides assistance for you to determine the Controlling Persons and how to complete this Appendix. Please provide details of each Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Fiat N/170 Jeffrey Dale or Si CounmfiCcuntriee al Tax Rezieence US Virgin Islands Is CoMmaing Prison a non-US BeneresoryinobUS Benet-Jab Omer? Lag NOMB Epstein Contreeng Pemen Typeable Trustor Yes (compseto Appendix 2)  no Fru Name Darren Lad Name Indyke Date or Sn Controlling Prison Twebote Trustee counimcounins. ol Tax Residence US b Controlling Person non-US Senefloaryinon-U5 Seremal °wren Flat was Richard Dale or setr CovnerComInts of Tax Renames US is Controring Peden a not -US Senormarydren-US Beneficial Cwnert First Name Mark Date c Bath Coontry(Countoes a Tax Residence US Is Conirceing Person a non-US ElenermerylnobUS Beneficial Ovens/ Yell (carnotite. Appends 2) st No L`m Name Kahn Controsn9 Pedre' TYPO"' Trustee Yes (complete Amanda 2) Yes moinotele alberale ve NO Last Name Epstein teraireirb Ponce, Typollicle Beneficiary Fesl rue, Lab Nat Date elf a Countiy/Countrim or Tex Rest r° US b Control:mg Persona non-US 2it4t Setselicaryinon-US ((enema! Owns, Each Controlling Person who is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2: BeneficiaryiBeneficial 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. se no Wasittair9 023511.041616 Per AI CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0043402 CONFIDENTIAL SONY GM_00189586 EFTA01357087