EFTA01357087.pdf

Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must be completed for each Controlling Person of the entity, but only if the entity has a tax residence outside the United States. Please refer to the attached Guidance to the Entity Self-Codification Form which provides assistance for you to determine the Controlling Persons and how to complete this Appendix. Please provide details of each Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Fiat N/170 Jeffrey Lag NOMB Epstein Dale or Si Contreeng Pemen Typeable Trustor CounmfiCcuntriee al Tax Rezieence US Virgin Islands Is CoMmaing Prison a non-US BeneresoryinobUS Benet-Jab Omer? Yes (compseto Appendix 2) ✓ no Fru Name Darren Lad Name Indyke Date or Sn Controlling Prison Twebote Trustee counimcounins. ol Tax Residence US b Controlling Person non-US Yell (carnotite. Appends 2) st No Senefloaryinon-U5 Seremal °wren Flat was Richard L`m Name Kahn Dale or setr Controsn9 Pedre' TYPO"' Trustee CovnerComInts of Tax Renames US is Controring Peden a not -US Yes (complete Amanda 2) ve NO Senormarydren-US Beneficial Cwnert First Name Mark Last Name Epstein Date c Bath teraireirb Ponce, Typollicle Beneficiary Coontry(Countoes a Tax Residence US Is Conirceing Person a non-US Yes moinotele alberale si No ElenermerylnobUS Beneficial Ovens/ Fesl rue, Lab Nat coy:omit littwn lvFollwe Beneficiary Date elf a Countiy/Countrim or Tex Rest r° US b Control:mg Persona non-US 2it4t Setselicaryinon-US ((enema! Owns, Yes (sabres Appendix 2) se no Each Controlling Person who is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2: BeneficiaryiBeneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely In the United States is not required to complete and sign Appendix 2. Wasittair9 023511.041616 Per AI CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0043402 CONFIDENTIAL SONY GM_00189586 EFTA01357087