EFTA Document EFTA01379554

II. Certification of beneficial owner(s) Persons opening an account on behalf of a legs! entity must provide the following information: a Nemo end Title of Netter,' Person Opening Account: -Tag CCP' me G . ) U Name of egal Entity. Iva of Levi Entily. anti itildrtt;53 of Legal Ent!v icr t1eT;;;Pt ACCOtelt !S geirta 0%4mo: 61O1 ?cre° —.. Ya.Jf c, 1 os to kis) o ta ct4uc4T C. ..)....itev e 83 11.-4,..s 1 Qs%) k Stolse_. Vot. Q. WI. 14 CP' t • 1.41C0-AP•""j C... The -Pt kyti!1:4 itItOcfnation for each if Elni. vthts, ',PrtiCt.ty ind:reCti`rs, through any cent understanding. rebtionship or othe!wise. owns 25 per cent or more of the equity interests of the -ract, arrangemat legal entity listed above: cog us. datst-IS 3eiitiSt!totey ! Notate Sava(Ef cp3 t /O4 s 0300 %era Rack. e..fovc‘v- € 4 was, ) OOqO,2,. For fl.Penot raft rootrava 1 he tbraW,ai. to Soroal 'Secority NOn-U.S. z,,Ititt4T)r el •tt;Di &runt"; ,ilitt,N o• 9 Pscstsgt VeitheC,“nay 4.0;)4P.C". 4ft :Son it-wliaalfr;.a!tindobt.:4 antitOunny JI osonnc at any ot hitt gOctt IOC°. Ors* taAnzWo a:Ala:0May ". fes.Alen‘e lad be:wog a phut gear arSmll.x tafeD:Aki antad ;A. wo-ine-a. (if flu a>5vidux mem alba catiatian. plEase AAUP "Rot .4.0e.cy4..1 d. The following information for one individual with signitkent iesuonsitality for managing the regal entity aired above. such as: • An etecutiva akar or sensx 'imager (e.g„ Chief Executive Officer. Chief Financial Offkriii, Olief ()prating Officer. Managing Member. General Partner. President, ViC3 President, Treasurer); or • kw otner ir-ciividual who reguiariy parka /MI &itftir fiarfinie.m. (If appropriate, an individual listed under section (c) above may also be luL>d in this secziun (ml of airip Leow Alciress Wcw-t E. Etaibet See_ Alocx -Q..- FtX V S.15 ,13!3 Saw Seurtf Natba PA, !k,$)A/.G. !Aar,' tfiCe kototrA I ke Oarf:Ata-ta to Gavial Set t oatt ;Lx!-LLS Peri il3Cfdri!A 3 a S:x.cal Ser,lit;:•aarte. sr a OstaNn ic,arave £warty of itworos. ar. ARnWar0.1.4glar HM muri&e, O &arab.. rend country etit“inCL!oi oty °the, gtrionmant-ifcioaa nev.woart tattle:mg hat VolinfOr nob bendra a phamtkoll Jt ciatlint lalft:474 vitatleO. (name of nature; person opening the account). hereby certify, to the beat of carap!ine and perfect -.gal Emay ;ae.iNfao tOpanoal: 21.G.3 Oc/tact...Sod; AG. Au • lab reser-AO ar.:169EN.i L12081,1 OS IfGe) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0077146 SDNY_GM_00223330 CONFIDENTIAL EFTA01379554