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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:
1
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:
Name
OM of Eterft
I Legal teldreS1
Fa: US. Persians: I For Non-U.S. Pnorts
Social Seca icy
i (See footnote i for alternative:
Nontay
f to Social Sacteky Numbel
1120/53
6100 RED HOOK QUARTER, B3
, ST. THOMAS, USVI 00802
I
Fo• Non-U.S. Persons. in addition too SoCial Security Number or a Passport Moshe' with Country of Issuance an aiion icentarcabon card writer. or nvenber
TIP °warn, 01 Osuonce 01 any 00,4: clover anser444Sueti ducks:rem ay:eta/wing nationally or resioenceand basting a photogtabh at ginfei; seeguarc smiles
to provided.
(If no ine.yitual meets this definiCen pkase write "Not Appticalgan
U. 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, en individual listed under section (c) above may also be listed in this section (d)).
Remo
Date of Sam
j Legal Address
For U.S. Persons:
Social Security
I Number
For Non-US. Parsons:
•
(See footnote I far afternelwal
to Serial So:utile Nutty)
f SEE
t ABOVE
For Non• US. Persons in addstion to a Social Security None or a Passoyt Nurrityar with Country of Issuaride, an afen Identification aka nonuser, or :lumbar
ono country of issuance of any other government-issued docUMent nqicencing nation:day Or residence and :meting a photograph b! similar safeguard tespaid
t,e provided.
my knowledge, that the
LegslErtlit le Identifier (Optional)
natural person opening the account), hereby certify. LO the best of
plate and correct.
7124/18
Dote
S,Fyi, r e
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0051726
SDNY_GM_00197910
EFTA01362344