EFTA Document EFTA01379556

Pre II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a Name and Title It Natural Person Conning Attomatt: ' A- -t e b. Name, or Legal EntitY. 'TVOn Cif Le.2ai Entfrr. anti Ad-drttss Logal E.Mity to, Whitth the Account it? Being Opened: T E G E-, c.. 'be. I 0,..›are_ (ot Or-) lamb kAticA.c. a -tv-i 93 t.3S+Jt tØaL 1,ne fo"owing information for eaoh individual if any. who. direeey or .i.direiCtly through arrf c.oritract. arrangement urder5v.te•5.'O •,::it)t..;r, I lip or otherwise. owrot 25 percent or more of Ehe equity interests cti the legal entity 'kind ~lb: r r 5.:fins Fof Pdr-4,14i: : 1,?:ackirir .:umbef C>lt:(O ea& k4...105)..).trier, 93 6 -'zlick,1 /4 q10 1C3 s ) °cut 00loa. "POI f%.'.1).S.ttresim. rno-"thzin Nr.:41..zy "iurnbef C PI .'t.enbev'flithnOunn't ;Xwara fit ego OlOnlifi;Eicgrcsardrzwnba..n. gizimtAt anO COUrit, of Binumticf !arr yin« tiov~nen!-Ntind dwurnent evid!firdr"; ittuo.naht, of f•ELIOOPOIOnd Dialing 1 olfixogript; olnOtir '311OW;Ifil ne kW. Of no rW4dual moet lo*Cr.. pkamniOp 'No! Appt:ultik!') :1. The following Information for one Individual with significant responsibility for managing the legal entity tisted 31.1t,e, i;tich 3B. • An (.3xiiC,ItiV5 officer or serCor manager (e.g., Chief Exr-utive Offictn. Chia! Financial Officer. Chie€ Operating Officer, Managing Memoir. Gener*! Partner, President Vita President, Treasurer): or • An.i other individue, who regularly f).rforms Smilar tuneitx:e al appropriate. an individual listed tender seettn (c) above may also be listed in this section cd». f.tte-4? 31!:h 1err.14 esa- Poi LES. ;),X50".. NOO• USO F7f1. fonrnon, plOonvinoes %otnti.ft IQ $4c4.11Socuntk ',IunBbef: Vtr.sy: A'AdiQt": tt.: 'SfX9Of bloi' f; O N:FOIXE ,tgb Comic/ sif `31,4ixO4, itsi SONO k ea.0~.Or , c-wk: itIrobetanuret+ff am endow, of baffle» nf any new 'metnineni-hitpx1OOCUrnen, ludic:audit," f......facnence ennienr.rar..)t bolds aaLlμ:kg 'hoolif Noridet. .-----(nar a of neural person opening the account). hereby certify. to the best of Knowted ovidett ObOVe Ltriplets and cfri^,,ct. ,Snnty t€11int4rf iQpncin+O t ft 4,' 20ai EiN:t;,,,,,..nse.A. AO. Ad si.?ht,t f61,4n.0(1. WAli 466'6 41D61Ø 0.41319 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0077149 CONFIDENTIAL PROT1 PROT0