EFTA Document EFTA01345166

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: 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: J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC., A 501(cX3) PRIVATE FOUNDATION/USVI CORPORATION 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 I Date of Binh Legal Address 1 For U.S. PerSOIS: I Seel& Seourkir • Number he NcuoU.S. Persons: (See footnote .1 for :Perna:ma( to Soda! Security felerrber) I, NOT APPLICABLE , --- 4 I i I• 1 I • NO:WAS.Personi. in addition CO a Social Sorority Numb."( or a Prop:et Plumpertvitn Country of fasuan‘A on alien dentificallon care number. Of "WM& anti country of nuance c1 onY oilier Oneernmeng-fasted document eviChtkary iedonalay or lasidence and tearing a ahocoaropn or aimilw tabgraard gleiva3 be provided. (ft nairidandiral enacts this definnlon. ,,tease orate "No! AoPhoobfe•-) 0. 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 (Cl)). Name Date of Bird, I Lsool Address JEFFREY E. EPSTEIN (1/20153 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 Social No For U.S. i (Sea foomote a for alsunaorasi Persons F : I Fa n•U S. aerSOM Noma.: ( to Social SeCcnty Numbs() i i • For Non-tf.S. Porsono in addition to a Soto( Security Numee: ut o Pasopart Number vat Courtly of Issuance. on alien kfuntificanon card number. or ramiber and country of is of any Oyler pCornorberarrarbed document ovIcarrtinp nebOnidity ar rairdente aid oteeeg a Oh01.0pralal or Pradr SelOarrara about be Dravaibl. FREY E. EP TEIN y knowledge, that tie info SI Leper Entky Identifier (Optional) me of natural person opening the account). hereby certify. to the best of is complete and correct. Signatur srpifruta4 Title: Date: z CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0031351 SDNY_GM_00177535 EFTA01345166