EFTA Document EFTA01380176

Email Cr'I4 olitrefidt irotaltOrarl II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the foaming Information: a. Nance and Title of Natal a1 Pei son Oonnine cccu•a. StA,e- kktie J.tv b. Name of t.egal Ernity. Type Legal Entav, and Adthess of Lege: fiN;ty *ex Which the Acsoimt is Being Opened: L C. LA-L. lc.tt-tA (colt, t. 41 k OO 'act? Pac;olz. 0.)., a2 LaSV1 °et Tha foikmeing infexmation for each inds.:ititial, if any, or !