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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:
1
b. Name of Legal Entity. Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened:
6100 RED HOOK QUARTER, 83
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
rate of Enna
Is Legal teltirest
i Fa: US. Persona:
i Social Seem ity
Number
' For Non-U.S. PN$OM.:
.
(See footnote i for altornativec
to Sochi Secteky Numbel
1120/53
6100 RED HOOK QUARTER, 63
ST. THOMAS, USVI 00802
• Rs. Non-U.S. Persons. In addition to 0 Social Security Number or a Passport Number vnih Country of Issuance. an a on rcenuticateon card Norte:. or nufnbe
and COWIrrY
amonce el any 00,4: Lfmar anserrt-iSsoeti Oucupent avk sencino nationally or refoenCe and beas ino apt wtograph
fiojei; saguaro sot: ift!
to provided.
(If no utdMeajai meets this dafiniCan. plea:evert. "Not AppOcalgen
U. 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, en individual listed under section (c) above may also be listed in this section (d)).
Name
Date of Seth
j Loom Ar..dreas
Feats. Persons:
For Non-US. Parsons:
•
Social Security
l Number
(See footnote I fa: afternalwal
to Soria( Security Nunstm0
f SEE
ABOVE
Fr Non. US. Persons in woman to a Social Security Number or a Passort Number with Country of Issuers:se, an afen Identification aka humor, or number
ono country of issuance of an/ other goeernmanhissute. dxtonentmidencirwa natiOnetky ar rgsiciance and :manna a photograph of similar safeguard:kilo:0d
t,e provided.
my knowledge, that the
LegitSW:1f Identifier (Optional)
natural person opening the account), hereby certify. LO the best of
plete and correct.
7124/18
Date
S,Fyi, r e
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0067034
SDNY_GM_00213218
EFTA01373043