EFTA Document EFTA01381086

li. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a. Nann and Title of Natural Pelson Ofrgning Account' Pr-frei '..Qs{-e0A 1 Sat (tk.'_,...46 -4 V b r.,,sru a of Lefg nOty. Type 7 02,1: E lot A.:count is Behlg Opne. 4..r (.04.0.ecuAl 610 0 k.kock Oucork•er g 3 Visa .-c..s L.1SQ ta$d1 c. The fogowing infOrinatiOn for each incliticipt1/4 an"). WhO, rlirtscdr or indirectly thr bact r :rough any con angement retcflirstrrri cro, Co C /II etrio:Cre. (),,,n5 25 per , :tint 'Y more of the et.piz interests of the legal entity listed above: cr.), U9. Permas For Henri, S. Pererrers -9Thlrir'21 faCtleot. Mr errial r+tzt Number to Sm. '441 St; i)(1:0144:»Diirl I i) 0(s-3 LaoleaMicbego.),Ae l e3 s4. c ?sit Cx3Exa Os MO:•-;33, ViOt: %IA SbAsiit(..4:111t. V 4 on s,>;)0, t kumacy woes:14(4SY (If an go , izLeinNf:=4.1 cold centre: 0; ryjet.,•1 Ind • x.z) n rr. of issuance 41 Vrt :the gOV•141111Wit.otirseel 71(4.01119,1-trrirdenting nation:Wry ar rewiecreetird be oteg a plcrtottazah et smitu tafewatIthorird sl no Atksual meats chit oefineitc, mese Mite '140t, APO:13NC, o The following information for one individual with significant responsibility for maneginQ the legal ernity listed above. Rrn es: • An executive officer or serthr managerteg , Chief Fttive Officer Chief FinantYal Officer. Chief Operating Officer, Managing Member. General Pdrtne.I, President. Vice President, Treasurer): or • Any Other irtzlirradrtibi yglio regularly fxrfotras &miler functions. of appropriate. an individual listed under section (c) above may also bt listed in this section (d)). 1)Ni, iq earn 14-4s)0, ..sz F":4 rtor ticort.t.S.itrirattt fACIAi f3fel !See:M.1W: 4iVer•tves PAIRIbe A>Sonid Sterility N,iertyio!. Fof ft.yrscrai.**. trorr 1* 4 S.41...".)!Switate kitriv•Ar r: Pusw..,n ra..yrtneWgr. C:42:1710f '4C-ithrza an xeierrir.trotitir.b1h-e:4.7St.dnbze. 1,141424:' and cVon: f.! zaw *thin Lifmennert.ose see ffewfvent Avithoiting oneenelhear mielyroe.ted be 10114 a iliretycirapir or *reef salegi.ectl esetij LOOM 5n7:e, 'deviled (Cptier )4/ of natural parson opening the accounti, hereby ceitify, fa the bast of ,cmpleie and tesfeCt. Co c to 201S Din estire ttairfr Ars AC NM*. ituler•tti. WhIgoe;64 nr3stkostass CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079833 CONFIDENTIAL PROT1 PROT0