Text extracted via OCR from the original document. May contain errors from the scanning process.
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:
b. Name of Legal Entity. Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened:
St DO RED HOOK QUARTER, B.3
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
Date of Binh
lliffdlAddren
, For U.S. Persons:
For Non-US. Persons-
! &weal Security
(See footnote I or °Rama:Nell
Numb&
to Social Secitt.y Number)
I
t.-
—1
6100 RED HOOK QUARTER, 83
MOMS
ST. THOMAS, USVI 00802
I
for Non-US Persons. in addition too Social Security Number or a Passport Number .win Country of Issuance, en alien identification card ncntz-..r. or num del
and tOtanty ci facoance oi any CAW" gvueinmeot-issued document evidencing nafianalty ce residence aro bearing a obotowaph o wallas scleguaw sygnikt
be provided.
(If no fr.drvidtsal meats Pis cafanitiOl dare write 'Not Applicabla.")
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)).
Pen
I
Date of Ben
I
SEE
Legal Address
ABOVE
I For US. Persons: j For Non-U.S. Persons:
Soctal Security
1
0
14. T. foo
Social
y
tnote I
Nimb
ak
t e.;flanks
ro
For NoruUS, Persons. in addition to 8 Social Security Number cr a Passport Numb*, %An Count!), of Issuance. en alien leentirtcauon Card number. ce maybe
wan country of Issuance of any Othe 90veffirnatnnudd of/co:11am' evidenCing nauortalityor rasktencc and basting a photOgraon at lenity safeguard Shaft
be DrOviCed.
kfriErFiltriPsmiN
(name of natural person opening the account), hereby certify, to the best of
/my knowledge, tat the information prowl
beve;seamplete and correct.
Signatu
7/24116
Date
Leos] £ntey Identifier iOptional).
stow, (1
Name(
Tale.
Data:
fre
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0067037
SDNY_GM_00213221
EFTA01373046