EFTA Document EFTA01381083

II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a. Name anti Titleal N-3Z.Lif01 Person Open ad Account: TitCC-rft oe. , ere b. frame et' Legal Type of Leger Entity. erg! Address ur Legal Entity for Which the Recount is Being Opened: V. !Fr-:\ c N4.) (St et ...SS, ) Sc; f1C•t if- s•a a.gaia.40-isee le‘ ..‘ (...)‘%1 S 4 .CLi.....st, 'AUL oa% o c. Try: follorring informat:rn for each individual, it any, who. directly CCI 4X6retailt. %hi .111O ?sot crantrnt, mrarrent understanding. relat;onship or otherwise. ovens 25 oafOOnt or more of the equity interests of the legal entity ilsted above: Ham.) De; e at Rd?, L.rrJAvi.f.:r3 For !I$ P•Kannt: C:x vari.uS. 3•Ittgih, <t.tett..x.4ra".ni I en: Aetna N•tn *tit( !<l Social SacgaiityMitrA)il) For 1....x:4,1 g, Peet.eint tricfrior t; a 5ti,t0, .Set‘etty ,tikettbst .1n 1 Ristira>st. ta.stittw /Alit cl.nireLie of iTwarct thinttficakvn CM* ”trobit. a rm--mtir and 441.21144y 4.1 .4411,111K4afans•vne tio,t.indient-ISSJed ch)Clitilefg tteltieettl:ln 11.4111111:? 0! ttaitience and 11M11W1c I Oh014434.Vi Of WWII 3.1i4SLAIII 4-64).4111 Nt itain.14011411,011 thtt C•Htetkeet, plefli!nril it riot rearkuJoiel d. The. Poilowing trtformation for one individual with significant responsibility ror managing the iogai entity find above. such as: • An executive offiatr or senior manager (e.g., Chief Executive Ofiket. Officer, Chief Operating Offrrat Managing Member. General Partner, President. Vice Presdent. Treasurer); or • An,' otMr individual Who rfil.:09? tr imly' FM1'101118 futxtio ns. (If appropriate. an individual listed tinder section (c) above may ;'150 be tinted in this section (d)). pact•V:Iiittt Fe.A Piwrxm. ta a $t-z- . andC.401re CrItiDtarieit NW Cflen ift)e., t• .ttS paage.1-0 I, A Cgretf . cfork tr.% n y knowledge. tNat t e int • rn Ltgai in:ay 4tot;fer (eviong.) 110*Atiesstek) • Fe/ U.S. PL•sswa PA;6:445ec;; et," ;tor I.4.7r14.11). Peqcr i.l.efotqr.);t fr.-- {tem:pr.:et - to Social Sta.:;ait". MUM 00 'ten i•Mmtik.riC-Tt Calf MIMI'S Cr nt.ertbor ti ploteiy.g)h CO POWS 4.0./W., touts (name of natwai person opening the account), hereby certify. to the best of ;_s tunplate and correct. ‘1201t, ileutiche Bat-.: ntl room. teSafroa, 1.,trvIleeMio 120.1i).(731418 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079830 CONFIDENTIAL SDNY_GM_00226014 EFTA01381083