EFTA Document EFTA01370190

Deutsche Bank Wealth Management Entity Self-Certification Form Purpose of this Self-Certification Form Deutsche Bank AG and its affiliates (collectively, 'Deutsche Bank") collect certain information, including tax related information, from their clients. Deutsche Bank collects this information to comply with certain local and international regulatory requirements that are designed, among other things, to foster and support a tax compliant environment. Although these requirements are not necessarily Imposed by all countries, Deutsche Bank, as a global bank that strives to achieve consistency in its practices among all of Its regions, nonetheless requires this information be provided by clients even if not required by regulation. Accordingly, Deutsche Bank Wealth Management Americas is writing to clients and sending you this Self-Certification to complete. This form is to be used in any situation where the Account Holder is an entity, and not an Individual. tf In fact the Account Holder is an individual, the individual should complete and provide the Individual Self-Certification Form which you can obtain by contacting your Deutsche Bank Wealth Management Americas Relationship Manager. Please note that a branch of an entity is treated as the entity for purposes of this Self-Certification and, therefore, the form should be completed with dearth for the branch, and not the details of its parent. Please complete ail sections below as directed and provide any additional information as may be required. For the purposes of this Self-Certification, 'Account(s)" includes any accounts currently held with Deutsche Bank by the entity. While Deutsche Bank Wealth Management does not provide tax advice. you may contact your Relationship Manager If you have questions concerning the Sell-Certification process. If you have any questions about how to complete this form or about how to determine your tax residency status, pease refer to the attached Guidance to the Entity SeIf-Certification Form, or contact your tax adviser or local tax authority. Ent i AcCountlitilIclor The 2007 Jeffrey E. Epstein Insurance Trust 03 Legal Name of En'Jty US Virgin Islands Carney Cl 'nougat/ton or Crganation Entity's Country (Countries) of Tax Residence US Virgin Islands If Entity Account Holder is tax resident only in the United States, please proceed directly to Appendix 2 (which must be completed by each non•US Beneficiary and each non-US Beneficial Owner). If Entity Account Holder Is tax resident outside the United States, please proceed to Part 2 and complete Appendix 1 and Appendix 2. Please Insert the Legal Name of the Entity In Part 1 of Appendix 2. WM167679 023811.041616 Pan of 5 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0062839 CONFIDENTIAL SDNY GM_00209023 EFTA01370190