EFTA Document EFTA01370181

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 Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Centro+gag: Pot ConCOMO Pinson L GonersDin* Penton Conlog! Parson Connor!' no Perina Fes Name Jeffrey Last Name Epstein Dal° °Deal 01/20/1953 C°^" Img Pecs" r s'Pef" ° Pres., Dir., Ben. Owner CountryCouMrles of Tax Residence US Virgin Islands Is Controlling Persona non-US Bonefinaryinon-US Elenercial Owner? First Da" Darrell Data al Dia/102/19/1965 Country/Coon/nes o! Tax Resedenoa US Is Connoting Person a non-US 6eneficaryrnanUS Benefigal Owner? Fist Name Cecile Dale of Beth 3/20/1962 Counb-sitountries of Tax Residence US Virgin Islands Is Controlling Persona non-US Benensiary/non-US tileneenal Owner? dal Name Dale of /Inn Cooney/Countries of Tax Residence Is ControAng Persona non-US BenendaryhectrUS Beneactal Clymer? PIN Name Date of Barth Country/Countnes of TeX Residence  Yes (oomplice 4/M00ot 2) NO Last Name inctyke ColLecanD Person TYPollala Treas., Secy., Director Yes (complete Appendix 2) -/ No Laal N." de Jongh Controlling Person TYPellaale Director Yes (complete Appendo 2)  No Last NOM) Controlling Person Type:Role Yes (cornolele Appendix 21 No Lest Name Controlling Penton Traeger° Is Controlling Person a non-US Yes {complete Paginate 2) No Benenciarygon-US Be ide:el Owner? 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. WM161679 023611 041516 Page At CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0062824 CONFIDENTIAL SDNY GM_00209008 EFTA01370181