EFTA01362470.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, SOLE MEMBER : b. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for which the Account is Being Opened: LSJE, LLC, A USVI LIMITED LIABILITY COMPANY 6100 RED HOOK QUARTER, B3 St THOMAS, USVI 00802 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 Dent of Binh Lepel Address rot US. Penont: For Nan-US Peso-: Social Security (See footnote I for alternatives Number to SocialSeaway Numbei) 6100 RED HOOK QUARTER, B3 JEFFREY E. EPSTEIN 1/20/63 ST. THOMAS, USVI 00802 1 For Non-U.S. Persons, in adohion to a Social Security Number or a Passport Nude°, With COWIlly of lssu not. on arse, identircerirm card numbs:. or nuttier and county? of issuance of any other vavarnment-issoto document L.:Wen:Mg nitinctefity Telide:we anc nearing a pncrluerann en sinfiter sateguero 0 OCOvWea. no indiekkne (reins %his dalwwtgn, please wit° "Not Atpticab:e.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. Of appropriate. en individual listed under section (c) above may also be listed in this section (d)). i Nam* Mateo( Beth Legal Address t For U.S. Penons: I For Nan-u.s.Pczeons Sotial Security Mee footnote I for ekeMaki% eturneet 10 SOSISecurity :lumber) ABOVE 1 !JEFFREY E. EPSTEIN I SEE FOr lean.U.S. Person& in addition to a Social Security Number or a Passport Number with Country of Issuance, en alien identlficat KAI card numbe. of number 4r4 COUIWY d ISSUtroCt of any other govenvnent-Serued documenr eeteerfefeo r•atichality as residence am hearing a oho:3gram or seater eakpare should bo provided, REY E. E TEIN ne of natural person opening the account), hereby ce to the best of m knowledge, that information pve Is complete and correct. Signature 7/24118 Stela Da:C. 77 14T—.C Name Legal Entity Identifier tOPtfamet) (Print):a_ Tale: Srprivre CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0051889 CONFIDENTIAL SDNY_GM_00198073 EFTA01362470