EFTA Document EFTA01380831

IL 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 I JEFFREY E. EPSTEIN, PRESIDENT b. Name of Legal Entity. Type of Legal Entity. and Address of Legal Entity for Which the Account is Being Opened: Fla INC., A DELAWARE CORPORATION 8100 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: i Name • ' JEFFREY E. EPSTEIN t Ock of Beth LegalAddress For US:Pe:sans: Fee Non-US Persons: Social Security (See footnote l for alternatNes Number In Social Seconty Nunibe) 1/20/53 8100 RED 1100K QUARTER, B3 ST. THOMAS, USVI 00802 1 ' For Non-U.S.Fleisons, in addition to a Social Securty fturnbes or a Passport Number with Coin; of issuarce, an Mien identiltatkra cart tint. or number and country of Issuance of any other government. issued document evidencing nationaky or residence ant bearing a F.:not:pion at safeguartl indult be prodded, Of no individual meets this deRnition. Please write -Not Anoilralbirai 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)). Name Oats of Sinn I Legal Acorns roc US:Persons: I Social Stour sty Number Frac NtimU S. Penonre I (Sea fcratroie blot alternatives to Social Seramly Number) !JEFFREY E. EPSTEIN j SEE ?ABOVE %For Non-u.S, persons. in addition toe Social Seantty Number ore Passport Number with Country of Issuance: an alien tentifioaticri card number, or number and country of trance:mot any other goveinetent-issted document trader-ling nationality or tesidence and bearing a photograph Of similar safeguard Sramid be provided. legal Entity Identifier (Optional) (name of natural person opening the account), hereby certify, to the best of KurprOCidedabove ' complete and correct. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079392 SDNY_GM 00225576 CONFIDENTIAL EFTA01380831