EFTA Document EFTA01345169

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 Address 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: Name Dete of Binh Lepel Address For US. Percent: Social .Security Number For Nan-U.S Preens: I (See footnote l for alternatives to Social Stagy fet.enbet) JEFFREY E. EPSTEIN 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 1 For Non-U.S. Persons, in adoition to a Seam Security /slumber or a Passport Nurntier vifta Cavity at lieu nee. on art:, ieentircorirel taro nuneeor. or senor and comity of issuance of any other vavernnient-issuto &proem C.:Wen:Ong datianafityb Ie90enee an° Wiring 0 oncrlograah en siteifer saieguero 0 eriMliOu. no indieiduat netts this deliiiition, please vote "Not Asplicab:O.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* Dated BOO !JEFFREY E. EPSTEIN I SEE i Lepel Address l For U.S. Penns: For Nan-u.s.Pcsonr. Seal Security (See footnote I for attenativa Noumea 10 SiXiDISecurily :lumber) ABOVE 11 FOr tiloniti.S. Persons. in cdidition to a Social Security Number ore Passport Number with Country& Issuance, on alien identification cord number. a number 4r4 COuntrY oi ieSute10 of any other government-issued docurrenr evtoencino nativetlity as residence and hearing a onotagrapn or sinew eakipato mould Po proviOed.. natural person opening the account), here to the best of plete and correct. 7124118 r Srpivre Signet Name (Print): 11 Title: CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0031355 SDNY_GM_00177539 EFTA01345169