EFTA Document EFTA01369140

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: MORT, INC., A USVI CORPORATION 8100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 L 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: Nana ,...... Date of Sian Legal Address j For U.S. Persons: 1 Social Security i Number For Nort-IJS. posy's. (Sea footnote I for alternatives' to Soma: Seamity Number) j )-- JEFFREY E. EPSTEIN 1/20/53 8100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 For NoMU.S. Persarahaddigon too Social Security Number or a Passport Number with Country of isstarice. an she kiontifwaticet card ntor(sec. or number and momy of issuance of any other government-issued document avittrnoina nationality or residence end boating a photozsaph or similar safeguard should to provided. Of no Individual meets this definition. bleaSe bake 'Not Aornicaole.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. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). I Name Data of Sinn Legal Address For US. Persons: For Non.U.S. Persons k Social Seornity Norther (See footnote 1 tar aitemativeS to Social SecuMy temmoce) [ABOVE JEFFREY E. EPSTEIN SEE For Non-U.S. Parsons, in addition to a Social Security Number or a Passport Number with CountryOf Issuance, an alien Wendt ration mud murex( or number and country of issuers* of any other govarninaM-issued document evidencing mitkemety ortesidence and bearing a ohotopmph re Dander safeguard *axed be Mutated. REY E. E =TEIN y knowledge, that the infor Legal Entity Worm! er (Optional) __ (name of natural person opening the account), hereby certify. tote best of provided above is complete and correct 9 7/24/18 Date CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0061248 SDNY_GM_00207432 CONFIDENTIAL EFTA01369140