EFTA Document EFTA01381921

IL Certification of beneficial owner(s) Persons opening an account on beha€f of a legal entity must provide the following ir.forrnation: :I. Hanle and Thie of Nature Pe;sor Opening Account: TeOPIreil ‘ r let..., b. NBn1-5 of Legal Entity. Type. of Legal Entity. wid Address or Legs! Entity the Account is Fiaint; Opened: 5.10. V0t.c4..L-e 4-1.Ane J t-L C.- ) eel coaelt k 641 &o+ .t. 4+.1 Cot 4no iaa Vecok ocevrhec e3 St r ki nsat.uc. g ) k—D,SQ I O 41,1a 0 - 1 it 7 ini,)Mtatir, Or .?3Ch 4t0. drretItii Or indirectly. through *Iv contrTc.t. arrangement, understaitoing, ielationship or ott-terwiSS, Owns 25 percent ni mole of the equity Interestsof the regal entity listedabove. Date of alrth twat, c efatylsoo P.,(114toVQ.... rcri usut bean.. p;;I. LI a P3130031 It umber set Peierit (.90+ tootrcu tc-ittttnallitea. to Social Seam') S011bOt} -Aar Non•u!..S.!isenit. zee...Avon vi 3 rkeitsi S......czutity Montero! ti !!'eanxin ff.miew !chat counly, Of .miarr..4 rso otiN. rat.o!, rmi4 !-,!snitnt or! AY)! rTI of issalOrtti . ett to? olfitz ;Int MA Wye!. intFOCI 006^Unlent evilest:tog ',atonality or /#70dEsttEd ann Naing a prmograoti tx 3.)lecpata stoAts t'a ce..widod. (If 1%0 iterth!i•itml meAs d!HislIttiti. *ono !mg, e "%to:AO:table 1 ci. The following information for one inr.lividual with significant responsibility for managing the legal entity listed above. such as: • An OXLiCtniVti officer or senior menace! (e.g,. Chief Executive Officer. Chief Financial Officer. Chief Operating Offcat, Managing Member, Ganef& Partner, President Vice President. Treasurer): or • Any other who reguiariy perfixins similar !kinetics''s. (If appropriate, an irecividual listed under section (c) above may also be listed in this section (d)). Ne, ".4 TeeCtei t Ws, CA ..i:t3a1 Mat tail Selev.8_ 1/4 0. 1.1.3. Ptiuttti: So: Moir Porirt:. to tot i roti.vn Nurottte ta Saw, Sotto to- mtonbirl - rot "rua.US ptA itt.;., 1, 3 6tt.tim:.!....stvilty >kit tire..! N5humint >Wrte, with Cotxr-efti ittustut,a, uen "Yin. I :Int ter, auTfthr. or pass*, min minor, of itiWartt of sr.. 09* gowto men t 411440 dot:it/nets eviot•nrirg n liCnahh c ItleffiNit Elnl:13,41110(1.1 nIntoq:30 0! -IntulOrtotfitottul +e t (name of natural person opening tha account), hereby sanity. to the best of err, nowlelge, trpt the int able onmlete and itOiier.:t. Silts:St ktontitior (ttstt tong) 20 :81)4u:who 94o,k AO. Ali (19itts tesernm. ViM1£9866 le IS CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0081129 CONFIDENTIAL SDNY_GM_00227313 EFTA01381921