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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
rate of Eterft
I Legal /O&M
i Fa: US. Persians:
Social Seca ity
1. Nuntaer
I For Non-U.S. Pnorts:
(See footnote i for alternative:
to Social Secteky Numbel
1120/53
6100 RED HOOK QUARTER, 63
ST. THOMAS, USVI 00802
• Fr Non-U.S. Persons. In addition too Social Security Number or a Passport Number on, h Country of Issuance. an eon identification card water. or nuenber
and
Pf lasoonce el any otlw gavot noser444Sueti 0ucurrent avk:ensing marooning? Of relmenceand basting apt wtograph at fiojei; fee cum work!
to provided.
(If no ine.itual meets this definit:On please vote "Not Appticaigan
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)).
Rome
Date of Sem
j LegaiAr..dleSs
For U.S. Persons:
Social Security
Number
For Non-US. Pa sons:
•
(See footnote I far afternelwal
to Sot-lagSecurity Numbs*
f SEE
ABOVE
Fr Non. US. Persons in adduton to a Social Security Nufroef or a Passort Nurntyar with Country of las:rinse, an afen Identification aka ninnotr, or :lumbar
ono country of issuance of any other gOveffifnat•iSSAIttl dot rnent nqicencing na00OIEHty ar rgsiciance and booting a photograph b! similar safeguard should
t,e provided.
my knowledge, that the
LegslEitlity Identifier (Optional)
natural person opening the account), hereby certify. LO the best of
plete and correct.
7124/18
Date
S,Fyi, r e
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0051892
SDNY_GM_00198076
EFTA01362471