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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:
61D0 RED HOOK QUARTER, B3
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
1
Date of Elkin
Legal Address
r For US Persons:
For Non-US. PONVIS'
SqicalSectr.ity
(See (Donate I Ior °Perna:Pees'
' Nomad/
to SoCial Scc;i0y Number)
6100 RED HOOK QUARTER, 83
1120153
ST. THOMAS, USVI 00802
far Non-LIS persons in addition to 0 Social Security :lumbar or a Passport Number '.'wen Country of issuance, an aLM idontifIcanon card mar
or nom per
and totafffy at fscoanee of any miff" cnneinnteot-issu*0. document evidencing na:IonalW ce residence WO bearing a photowadtt ry *Inger salecuaw shook.
be provided.
(If no individual :nom din definition. darewrite
Applicabl4")
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)).
came
Date of likrn
Legal Address
SEE
ABOVE
I For US. Persons: j For Non-U.S. Persons:
r‘ot:nti Security
oer
I IS: foo
Socjaittiota i fainak
timebt fithys
For Non-US. Persona in addition to a SOCIalSeCority Number cr a Passport Number wan Country of Issuance. an :Men hileitireltiOn Cale number. nr ftahhtf
:MO CtItIfitfy of inane of any other government-issued uocontenr avieencinr, hohanalhy at cask:ante and Om mg a photograoh or sisnOw stgegootti shout
be DrOviCa.i.
v lEFFREYSEPSTEIN
(name of natural person opening the account), hereby certify, to the best of
my knowledge, tat the information provi
mplete and correct.
Less, £stay idaPifier (Optionall
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0051729
SDNY_GM_00197913
EFTA01362347