EFTA Document EFTA01392835

III. LEGAL RESIDENCE. Jeffrey Epstein Name Name United States Virgin Islands Country of citizensh 0 Country of citizenship 6100 Red Hook Quarter. 03 Legal residence legal rot den...N, St Thomas, USVI 00802 You volt notify us immediately if your citizenship or legal residence changes. IV. DECLARATION OF TAX STATUS This Agreement is designed for use by both U S. Persons and Non-U.S. Persons Please check the box next to the paragraph below that applies to you. You certify that you will notify the Bank in writing immediately if the representation certified to below ceases to be true end correct. (choose one) U.S. Persons. By checking this box, you h ' er penalties of perjury that you are a US. person Your Li Taxpayer Identification Number i Ynu further agree to provide the Bank a validly completed Internal Revenue Service Form W-9 Non-U.S. Persons (Individual). By checking this box, you hereby certify under penalties of perjury that you are neither a citizen nor a resident of the United States (and you have not made an election to be treated as a resident because of your marriage to a citizen or resident), you have not been and intend not to be present in the United States for 183 days or more during any calendar year in which this Agreement is in effect, and the income you will earn hereunder is not effectively connected to a United States trade or business. You further agree to provide the Bank a validly completed Internal Revenue Service form VV.8lIEN. W.BECI. W8EXP or W8IMY or any equivalent successor form as may be appropriate to your United States taxable status at account opening. V. TAX REPORTING FOR U.S. CUENTS HOLDING NON-U.S. DOLLAR SECURITIES U.S. tax laws are quite complex and constantly evolving. especially in the area of international investments held by U.S taxpayers. The monthly transaction statements and the annual consolidated form 1099 furnished to you ere designed to reflect the status of your investments, but do not provide all the necessary details to complete yew U.S tax returns. The supplementary information needed namely historical foreign exchange rates, is available on the Bank's system and can always be provided to you or your tax professional at no charge. An annual International Tax Letter for foreign securities, which provides a detailed summary with supporting schedules of all capital and foreign exchange gainsflosses recognized, is available to you upon request. Additional charges for this service would be noted on the fee agreement provided to you. Any (barges will be deducted from your Worldwide Custody Account unless otherwise instructed by you FOR HOLDERS OF FOREIGN SECURITIES ONLY—Please check the appropriate box below. (choose one) I do not wish to receive the annual International Tax Letter. I would like to receive the annual International Tax Letter for foreign securities. (Additional charges will apply Please see your fee agreement.) Note I. For U.S. canes holding any foreign soCurevr4 Note 2: My charges wei be prorated and based on the lee schedule signed with AMA Custody. DBTCA. List Additional re Name Add: ass its cf tax summary letter and year and tax forms: Name Address Vail 134649 2 OIE429 122413 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0098104 CONFIDENTIAL SDNY_GM_00244288 EFTA01392835