EFTA Document EFTA01379583

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 of Natural Person Opening Account: IDarren K. Indyke, Treasurer b. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: _J Gratitude America, Ltd., a U.S. Virgin Islands not-for-profit corporation and 501(c)(3) private foundation 6100 Red Hook Quarter, 63 St. Thomas. USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Nair! Date of Binh Legal Address For U.S. "%sons Social Security Number For NonU.S. Persons: (See footnote 1 for alternative.' to Social Security Numbed Not Applicable For NontU.S. Pelson& in adcbtion too SoCial Security Number or a Passport Number with Country of Issuance. an alien identification core number. a number one country of issuance of any other goveuertnoissuel document evideocinp nationality Or residence and bearing a photoylaph or similar safeguard should oe provide*. (If no individual meets 0da darmiti0rt. please write -Not Apylicablel d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as: • An executive officer or senior manager (e.g., Chief Executive Officer. Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President Treasurer); or • My other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). Name Date of Birth Is Legal Aim:km Darren K. Indyke 02/19/1966 L or U.S. Persons: Social Security Number For Non-U.S. Persons: (See (Wined 1 for alternatives! to Social Security Number) • 'For Ntr'ot.I.S. Persons. in 4c:titian to a Social Security Number ore Passport Number with Country of Issitanfwt. an aWii identification card numbe. or number and. country of issuance ui any other government-issued document evioencing nationafity or residence and bearing a photograph or similar safeguard abase be ctinocri. I Darren K. Indyke (name of natural person opening the account), hereby certify, to the best of my knowledge, that the information pr 'dad above is complete and correct. Signature August 15, 2018 Date Signature • Na Legal Entity Identifier (Optional) Vui'ief vi te-c3 -Pro v Date: Tom: 1.- 2015 Dena* Gana AG. AP trots Leserven. ViiN1129866 osatna.osurWedito; pnr License_ VP 15"Mati 47Ih 7. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0077191 SONY GM_00223375 CONFIDENTIAL EFTA01379583