EFTA Document EFTA01345288

Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must be completed for each Controlling Person of the entity, but only if the entity has a tax residence outside the United States. Please refer to the attached Guidance to the Entity Self-Certification Form which provides assistance for you to determine the Controlling Persons and how to complete this Appendix. Please provide details of each Controlling Person below. PleaSe continue on a separate sheet if necessary (and attach to this form). First Nam*. Data of Bret Cedniferrourcaes of Tax Rawdense US Is Contrclling Person a non-US Beneficaryinon-US Beneficial Owner? First Name J e ffrey Dale of Binh CdtaNYCOuntAn of lax R4140€04, US Virgin Islands Is Controlling Person a non.US BeneficiarylneAUS Beneficial Owner' Feet Name= Data of BIM Countryfeountnes of Tax Perulence US Virgin Islands Is Controlling Person a non-US BeneeporytnorhUS Beneficial Owner? First Name Dale of Seth CountrmteuntrIes of Tax Resallsece US Is Cmurofing Persona non-US BenoficeryMon-US Beneficial Owner? Felt Name Date of Sidn Country/Counines of Tax Refidence Is Cadrolling Person a now US Beneficiary/non-US Bennactel Owners Each Controlling Person who Is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2: Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely in the United States is not required to complete and sign Appendix 2. Lest Nacre_ conlfeanc Felfor TPPRee President Yes fcomrdote Append& 2i J No La" Nora Epstein Cm/I.:ding Ps3" TYPRIfin'" Director Yet (complete Appendix 2) pi No Last Nemo COrdrOttlog "MOP fyriemelfl Secretary, Director Yes (confiolete Adders* 2) pe No Last Nate Caw-eine Munn TrDotl°41Treasurer, Director Yas (complete Aw.nd 2) No Lath Hanle Corstolling Renee tvaNfide Yes (ccemlete Adoemfix 2) NO wm167679 023filt 441516 Page Al CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0031545 CONFIDENTIAL SDNY_GM_00177729 EFTA01345288