EFTA Document EFTA01379577

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: IJEFFREY E. EPSTEIN, SOLE MEMBER b. Name of Legal Entity, Type of Legal Entity, and Andress of Legal Entity for which the Account is Being Opened: LSJE, LLC, A USVI LIMITED LIABILITY COMPANY 6100 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: Karr< Date of Birth Lepel Address Fos US. Pettont: Social Setutity Number For Nomi).S Peesono: I (See footnote I for alternatives to Social Setwey fekenbei) JEFFREY E. EPSTEIN 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 1 For Non-tAS Person; in aeloOion to a Spec( Security Number era Pooport NufTeOr Witb Cowilry al Issu nce. on art:, iclentircorim taro number. or simmer ant comity of issuance of any other vorornment-issutu &Omen, L.:Wen:Mg natianafityb Tesicenet anc Canting a onolograoh a oinuler sategueto sheotcl 0 orovreicu. (If ref indleinuafmetis %his clefitlition, please...ate "Not Aracab:t..1 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. Of appropriate, en individual listed under section (c) above may also be listed in this section (d)). i Nam* Date of Beth !JEFFREY E. EPSTEIN I SEE Legal Address t For U.S. Fenons: I For Nan-u.s.Pcsoor. Soetet Security Met footnote 1 for aeornalivn Ranted 10 $0601Securay Number) ABOVE 11 For alon.U.S. Persons. in addition to a Social Security Number ova Passport Number with Country Of Issuanet on alien identlficat ion cart numbe. a number 4r i countrY Of anoint* of any other govenvnent-ithued docurrenreetoenemo notichality or residence am bearing a oho:3gram or sineee sok-pate should be oroviOed, m REY E. E TEIN knowledge, that information Sire Lego: Entity Identifier fOPticael) ne of natural person opening the ac ove Is complete and correct. 7124118 Da:C. r Srpiv re Name (Print) Title: Date: CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0077182 SDNY_GM_00223366 EFTA01379577