EFTA Document EFTA01370945

14 QV% 0 1? 6too tct& II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: I P."•":" Ootni r`O Sake_ kikt.tust -ec, L)SA/1 t-6•04 esti.,0-ktri 63 °Skil Oc.)Vfl, hat:J.11 3-eceni ctp.64, lox, In (g oatee's gOOLC. 4)0•4(1,- t aiwa. I UC0I 00c4 12.., at•:, !,, i 1;:ir Ay? ,,;; T; 7rs• 1;•. "•tt: ;• • =It... : •• .,..fw..)1;•..* ' ..:-.Y :7v • 7":•:i. '7. 4 6"'t • hi, tclk.'vaig •rilr2rmad)ii rex are ..x.e:vidual WC)" 3:gr:);,:.in, fri0011M:.'ti critic.11.:":"; fig 14123. SOCil • An exect,i,..ec.,f(Ctlf or Sen.Ce mena.,4er Chet Ef•e•Ltiftvu OfIv:er. Cb.st Dotn•Efri2 ldlciag:ng Mq•rnifer. Prisvtent. Vice PresiOunt 7-east,nyry • t'm., ofb-sc wiy• refit:4%0v per:Aint tn.:P...4)(!Zre. 11(1 :1:..)VI:t.t3i :Cr•!Ci !VAC:* SC- 11 -11 100, •:: i'LtCs• :E•itz t3.t..'t!til• ;5;t: LCS4- E. etaeun See A.Lc.,s2_ knowleec?. .a. •• 10211Ift ,yinactare person opvrtrej Op account!. ne; ety crodv. :o 7E bas; of r,OrrIPme And Ca 1c Signature Name (event): Title: Date: gi f2..0 /O- S La4;4t4.-e_ Itz.4 NJ a (vitt,- \it> CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0064049 PROT1 10233 PROT0