EFTA01365777.pdf

BY SIGNING BELOW CLIENT ACKNOWLEDGES THAT: (1) CLIENT HAS RECEIVED, READ AND AGREES TO THE TERMS AND CONDITIONS OF THIS WHICH CONTAINS IMPORTANT INFORMATION; AND (2) THE INFORMATION CONTAINED IN THIS ACCOUNT AGREEMENT, INCLUDING THE APPENDIX ACCOUNT APPLICATION IS ACCURATE. -... - AT SECTION III, PAGE 6. AND CLIENT CLIENT AC EDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPUTE ARBITRATION CLAUSE AGREES TO IT RMS (ALL ACCOUNT AGREEMENT SIGNATORIES MUST wrnAu. INFDALHERE• PROVISION OF THIS DOCUMENT OTHER 11IAN THE CERTIFICATION THE INTERNAL EVENUE SERVICE DOES NOT REQUIRE CLIENTS CONSENT TO ANY REQUIRED TO ESTABLISH CLIENT'S STATUS AS A NON-U.S. REQUIREDTO AVOID BACKUP WITHHOLDING, AND. IF APPLICABLE, THE CERTIFICATION . PERSON AND OBTAIN A REDUCED RATE OF WITHHOLDING Department of labor regulations require OBSI to disclose to a responsible plan fiduciary Important Information for ERISA employee benefit plan dente: U.S. information in connection with the services that DBSI provides toe plan. to assist the fiduciary In evaluating the reasonableness of DBSI's services and certain .db.comramericasterdedsa dlsolosure_pcsNml. By signing below. you &scenes/dodge related compensation. The disclosure Is available online. at http:AWww.pvem seMces to the plan. you have read the disclosure and you understand the disclosure. that you aro a fiduciary responsible for the procurement of DOSI's OWNERS MUST SIGN): Individual or joint account (IF THIS IS A JOINT ACCOUNT. ALL ACCOUNT CONFIRMATION OF TM AND COMPLIANCE RESPONSIBILIT IES obligations and any other regulatory reporting duties applicable In any relevant jurisdictions that Client acknowledges having sole responsibility to fulfill any tax Client's may arise in connection with assets. Income or transactions in account(s) and business relationship with OBSI. WITH RIGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES. CHECK A BOX BELOW ONLY IF CUENTS DO NOT WANT JOINT TENANTS CUENTS SPECIFY INSTEAD: • Tenants in common; or retains SOY. Interest In the community property upon death of the that spouse). Community Property (for Married couples In certain stales; each spouse O Date Signature SSN/EIN Print Name Date Signature SSN/EN Print Name Date Signature SSNrEIN Print Name Corporation, partnership, trust or other entity: CONFIRMATION OF TM AND COMPUANCE RESPONSIBILITIES to fulfill any tax obligations and any other regulatory reporting duties applicable to in any relevant jurisdictions Client acknowledges having sob iesPOnsibilify or transactions In Client's account(s) and business relationship with DBSI. Furthermore. Client confirms that the that may arise In connection with assets, income knowledge and capabilities) la made available no kin than annually to the relevant beneficial ownin(s). SOMOIN. necessary Information (to the best of Client's that may arise for such presents) In connection with Client's betieficiaryfica partnfithi. etc. to enable such Person(s) to fulfill any respective tax obligations business relationship with DBSI. Southern Trust Company Inc Employer ID No. _ Name of Entity Signet.* of Officer. Partner, Trustee. Authorized pr/ w.......„...2 Date t-') (11. k NamerTmeJeffrey Epstein Print ------- Dale Signature of Officer, Partner. Trustee, Authorized Party Print Name/Title Date Signature of Officer. Partner. Trustee. Authorized Party Pint NameRitle 13AWM-01943 7 012145.032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0056872 CONFIDENTIAL SDNY_GM 00203056 EFTA01365777