EFTA Document EFTA01580058

Funds Transfer Request (Piss Typo instructions) J.1 Morgan USD Transfer Inlermation Effective Date: 10/11/13 Please enter anent or Muni des only Select Appropiate Payment Type and Fields will be Displayed O JPMC Transfer O ACH 0 Chedc Principal: Quit Iridm Debit Account N: $900.00 ® Domestic Wire O International 41/ire Income: Debit Account Title: [Jeffrey E. Epstein Rec.° vInli PP'ty In torn isaan Receiving Bank ABA: Receiving Bank Warne: Beneficiary Account if: Beneficiary Name: Ism JPMorgan Chase Mom Address 1: Address 2: City: State: Zp Code: Pay Duay4hi:ntervisnalary Pa: ty iii Required Account Type: O DDA (US) O Swift O Other Intermidary Bank Account/Code: Intermediary Bank Name: Other Payment Details (Reference/ Advice Description/Addenda) Relmb. medical tudhottred By 10/11/13 Date ID: 036310114004156 DATE 1011/2013 20 3100 Page 3 of 3 DID: 8887316607 CSID: iNDEXt: INDEX2 Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00059296 EFTA01580058