EFTA01380834.pdf

II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the following information: a. Name and Title of Natural Person Opening Account: JEFFREY E. EPSTEIN, PRESIDENT b. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: MORT, INC., A USVI CORPORATION 6100 RED HOOK QUARTER, B3 ST. THOMAS, USVI 00802 L c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding. relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name Date of Sian Legal Actress 1 For LES. Parsons; For Pon-U.S. peter's. 1 Social Security (Sea footnote I for alternatives' ,_ i Number to Sem: Seamity Number) j 6100 RED HOOK QUARTER, B3 JEFFREY E. EPSTEIN 1f20/63 ST. THOMAS, USVI 00802 For Non-U.S. PersarahaddlOon too Social Security Number or a Passport Number with Country of issuance. an saw, kientifwaticei card nter(er, or number and country of issuance of any other government-issued document evittrnoina nationality or residence end boating a photogtaph a similar safeguard should to provided. (if no kWh/mu& mars this definition. ON4Se write 'Not Apricaola.1 d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as: • An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner. President, Vice President Treasurer); or • Any other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). I Noma Data of &In Legal Address For US. Persons: For Non.U.S. Posons Social Security (See fornote 1 ter aitematives Ntimiber to Social &coral (*mow) k [ABOVE JEFFREY E. EPSTEIN SEE For Non-U.S. Parsons, in addition to a Social Security Number or a Passport Number with CountryOf Issuance, an sin Wendt ration card number, or number and country or Muerte of any other governinaM-issued document evidencing rationality ortesidence and bearing a ohotopreph re sender safeguard *arid be mottled. REY E. E =TEIN __ (name of natural person opening the account), hereby certify. tote best of y knowledge, that the infor providedabove is complete and correct 9 7/24/18 Date Legal Entity Worm! er (Optional) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079395 CONFIDENTIAL SDNY_GM_00225579 EFTA01380834