EFTA Document EFTA01375822

II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: J. Name and Title of Nobiral Person F.:miming Account: .7 ala C• ‘.—N e b. Nerneof Legal'Entay. Type of ; T.S4.0•P&42 5 .1r...nt. • a US 1/41 t Carr Clogs:4-6f (CR tar. ti—oc...-es, 1 OsVt CoVti Trt Viowir:2 infoimazi3n for each €ndMdue •.•.; • incwourittalg. relationship O1 other tyke* °Wile. 2'. Pe: tf.tn,t. Adrpeo, • throtTsh any coni.r3ct. 74fTengetreat. I • .24 the equity interests of the legal entity listed above: ! Fir tl.S. Dortzwa f Ft? Avseoi: fiCtiJiaacnitto : :Set fors:A3 t fe i:rt£th?3 feign*. . Witt Bettie!, !Nonni') • oo ea& \--‘6oktansgF-tv TA...-, 1 C 3 ya s -t-- or novo ' F.or Hon.LIS thetoOilt tO8 :3COM inKoriog'Atintof of NIV“XM *mu t.of vo:e Cerro; ef ommv. 3g:) jemilkatjmn cm! rgram.: dI ranbcr 4hdotsirlt., M iraMtrirs M Sc;; Mhte 9itotiottiont • Issue/ 0e:erne* evide,ca* ertionoloo rtudzeoe and bettroo ti phatotyraph *tale tith!qt,:ilti itrOMd trtt WOsiCed. VI no Int:4,0w: ineiro ;hit .crvri:„kott..1 d. The following information for one individual with significant responsibiliti for managing the legal entity listed above. such as: • An tixfea/tivil officer Or seicror manage! (e.g.. Chief ESEC,JriVe Officer, Chief Pinanciai Officer. apes °parapet) Ottlar. Managing Member, Genet al Pacifier, Pr?slident, Vice President, Treasured: or • Any Mhei iiviivkinal who iegulariy similar functions. OF appropriate. en inthvidual listed under section (6 above may mac be listed in this section c(1)) Te4r41 6. (-141,,,e1 Oats of SO LeTa AitSets Sc a 14ACaiCa VS. Ariwi:, ti Socioi Snot," r.ilfribUr CrMtr4tiVel: to Swat! SIC), $ry ter YxrU4. gettOrf. ir :tarn. tiOn •:•)Sci.-o.l SnootyRunt." j9;0F,"'....21H6Int,Mbt r. Ce,ntc tlf 4Viadra en gen oientlf:rothon‘recesentne. n floater io-O ten? of &mance of Peri artier tAwbfolii/Mrtoi;,igri dytuttinill gontiOntAl d tWatOin) a fibutailrairin 7i tratet be oz.:relict ri. iv:cif:14c "let the .non . WO trig? lender (Coy Knool; rtail* , mined above is co. _ 1 - atural person opening the account), bereft/ certify, to die best of :Oleic and (iv rect. (Oki Er i IN,.ptscht Soot alts. Ail ocks t:£. WM10.C.V..1 0.25giitiS181.4 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0071445 CONFIDENTIAL SDNY_GM_00217629 EFTA01375822