EFTA01375831.pdf

II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: h. Name and Title of Natural NM')ri Opening Anct,gmt- b. (4,:m-.? CYO" -K . 4_ ma-3 WIS.C.LL Type of !.egad Entity, i.nel Address 0t Legal Entity for Which the Accaum iS Reing0pene.d. W c.Z.c.S.S Cov....2. LZ.06 -1-:11 A..% \co wt Lad ix: (.4) Govat:00.4 gerl • FL ) ii14 / ? ) N] / 1 14 c..r1w. fdlawcno information ro, each individual. if any. who. ci :cell;: or indimotty. through any contract, arranarnent, understanding., relationsnip et otherwise. owns 25 percent or more of the equity interests of the legal entity listen atma: Situ: t ttot : F'0, VS, PO:st49: For no01.1 g. flung t: Siuy.rey 1•44,•::-...4, tiff fr.f:lyto; 6(060 0 Strad Sscutt ., rve „,.„ 14/,,..ra,z t v, 0 i t(k. k c... €05 - 14-434.0.-s v,4a.wc rat i N/ I 00 iL ' Fel Rotsti.S. Pot sow. in tuir*:::0 tortaalSorstriti Uisottr 0; s Slawscsi Nitontsr wit; Ctsint, of :soittra. to okte,e4066:- ...ition card rtointet rr isarittur siti wort y nemnm tic any Olaf tyrtelst•Sett-0.440t1 Oct: attiOnt thoctsothv notion ttily0t alto:IL-not ac:d beatin9 3 or4.4ogiap11 Ototwita Softigattd ctiStii*s. (trro 00vetitst; 'swts 2htL mehniten. oases -,i0t '1%16146061 d. The following information for One intliVeriUel with significant responsibility for menacing tha legal entity listed Gboie, such a9 • An. exe..-,A;thre serioy manager (ea,. Chief Executive Officer, Chief Finfeicial ("freer. Chief Creating Oflitor, ;vtanaging Member, General Partner. President. Vice President. Treasurer): or • :4'41y other individual who regoiadv performs sender !unctions. (If appropriate, an individual NAPA under section (c) abort may also be OSteri in this SeelkAl Kfn, n^.tLOr y~ill LOW- A 0001s i•fir LES, n0;ttor0: LI a fAx:,:(,!: 4Si,.. tottVo fct si:sorstives :tt St»I SecorSo -Donfamvii4 /Jilt act. Alpo ...it • For Unn.1.1.S.PFtorba r aciagv to s Sesiti StrottyNiinbte co a f.)).t al Saone.: 74'4; ittottiote. so got; tthettio.ati000sn't z?ifikt,,,t. '4! ialhiiNef SOUI1D} eSAIIIItit, "0 . 0.y ^lb.,' CI, Afal •Inatnott instsitsnp I 06000? or .1.14.CtISC.0 N:1bust leo u oilwoo:bon or &loam stottato 01; bC OgOv:delL b cortrt4-.g.- tn+5( Lk- do (name of natural pia('Son opening the account). hereby certify, to die best of COMPlett and ter1901.. (O1Bel k2' Leff0 ioth, dtatifiar• Mod:541111i f) 101a Demute 0101Ms. As fitte:t r oat„,ir j. wsilsoim 016619.0:; len CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0071455 CONFIDENTIAL SDNY_GM_00217639 EFTA01375831