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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
b. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened:
6100 RED HOOK QUARTER, 83
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:
[Warne
Date of Olin
LeviAdd:ors
I Per U.S. Persona..
Social Setooty
Niumber
rot Non, U.S Pomona
(See fitCtnOtt t 40r slim natives
to Sosiai SeCu,41 Writhe)
i
1/20/53
6100 RED HOOK QUARTER, 83
ST. THOMAS, USVI 00802
I
[----
i
I
.
,
For Non-U.S. Persons, in addition to a SocelSeturey Nu:aim:or a Passport Number with Country of issuance. an alien identification taro nonter. Cr numaer
and county of issuance of any outer goyeenment4ssued document eventing nationality or faSiOenCt and bearing o coottirtedn Of Serhir sgeount silted
bo motiocc.
(If no indMinual meets snit definition. please virile 'Not nparkatgoi)
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
• Any other individual who regularly performs similar functions.
(If appropriate, an individual listed under section (c) above may also be listed in this section (d)).
Nam.
Date of Beth
Masi Address
For U.S. ref:west
i Social Secunty
woman
I ABOVE
For Non-U.S. PaSene
pre footnote for adernaitivitsi
IC Social Securey Nutrato
' cog ttomU.S. Persons. in addition to a Social &Minty Number or a Passport Number mat Country of Issuance. an goo ide.nercation card numbe, oi number
and country of iscuence of any Other 9OvorrentnI•isSued document pottlineing not:Cray Or resmenro and tittering 3 ronotograpn or tint
salegualo should
be provided.
EY E.
TEIN
m knowledge, that t
information
Legal Enter Identifier (OnSonal)
e of natural person opening the account), hereby ce
to the best of
,eve is complete and correct.
Signal.. re
7/24/18
A stempiAve
SDNY_GM_00062013
Name
(Print):t_
()etc
CONFIDENTIAL - PURSUANT TO FED. R.cp.,NEIDENTIAL
DB-SDNY-0024838
EFTA_00 I 72523
EFTA01298071