EFTA Document EFTA01357090

NO Cc41" .41)PerWmTwaitts Treasurer, Director Yes lOoneWe APO/ends 2) .1 No Iasi Name Ceeeretreq Penns Type/Rote Yes (camplole A opendb 2) NO to t Name Corlroten Person Type/Role Yes (neromme Apoecnor 2) 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 seoarate sheet if necessary (and attach to this form). atria Hama Jeffrey tau Nam•Epsteln Dote of Elrlh 1/20/1953 ConIzoln-4 Perron TypoRole p--res Dir., Ben. Owner CoonlrylCountnes of Tax Recioen« US Virgin Islands Is Control...ID Parson a non-US Benefpcorylnon-tIs Bone:Wei Owners Fat Namo Darren Dale of CounfrytCoonoes o ax es nu US Is Con:Pang Person a non-US Elonefitiafyinon-US Beneficial Owners Tns (console* AOPenta 2: No l 'INNa"Indyke eunIti" Perron TWe'Rfle VP ,Secretary. Director Yes (COIVelo AppervM 2) Nall Name Richard " IN "P. Kahn Duo of CoviewCounves or Tax Residence US Is cosirowq Person a non-US Benolidery-Mon-US Elepencal Owners First Name Oat. of Bulh Counby/Crainines of Tax Residence Is Confolitno Person a non-US BenefIcInynsoft-US Benenefal Owners First Nan* Dale el Beth Countnr/COuntnes of fax Re-science N Contitihno Person a nen-US eanernistymen-US Sanerntei Owner? Each Controlling Person who Is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2r 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. NO WM167679 0236(1 041516 Pool Al CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0043406 CONFIDENTIAL SDNY_GM_00189590 EFTA01357090