EFTA01357091.pdf

If Non-US Beneficiary/Non-US Beneficial Owner is an individual: 1. I hereby certify that for the purposes of taxation I am not a tax resident in any country other than the country/countries indicated above. 2. I confirm that my ownership or other interest in the Entity, if any, is appropriately disclosed in accordance with applicable laws and regulations in the countries in which I am tax resident and may be required to be reflected in my tax filings. 3. I confirm that all income or capital distributions received (or deemed to be received for tax purposes) by me from the Accounts) have been, and going forward will be. taken into account and included in my relevant tax filings if required by the laws of the country (countries) of my tax residence. If Non-US Beneficiary/Non-US Beneficial Owner is an entity: 1. I hereby certify that for the purposes of taxation the non-US Beneficiary/non-US Beneficial Owner is not a lax resident in any country other than the country/countries indicated in this self-certification. 2. t confirm that my ownership or other interest in the Entity, if any. is appropriatety disclosed in accordance with applicable laws and regulations in the countries in which I am tax resident and may be required to be reflected in my tax filings. 3. I confirm that ad income or capital distributions received (or deemed to be received for tax purposes) by me from the Account(s) have been, and will be, taken into account and included in the relevant tax filings if required by the laws of the country (countries) of tax residence. I agree that Deutsche Bank may disclose this Certification and any airier information related to it or the Accounts) now or in the future held with Deutsche Bank, to any relevant lax or governmental authorities of the country in which the Account(s) is/are/will be maintained or of any country in witch I may be liable to pay taxes. I release Deutsche Bank from any obligations of bank secrecy, confidentiality and/or data protection under any applicable laws which might otherwise preclude the disclosure of such information. I acknowledge that the data protection taws of such other countries may not afford the information the same protections which it receives in the country in which the Account(s) ishwehell be maintained. I understand that this waiver will remain in force until cancelled and notwithstanding cancellation it cannot be terminated retroactively. I declare that all statements made in this Self-Certification are, to the best of my knowledge and belief„correct and complete. I undertake to advise Deutsche Bank promptly of any cha cumstancesif_whicfiTam aware of and that causes the information contained herein to become incorrect an o provide eti6sc,herSankvath a suitably updated Certification within 30 days of such change In circumstances. Jeffrey Epstein Pont Nome of Senor SipruNorn 04.28-2016 I ;lir , ! .•; ; ICIV t 's Dale (min-cldiryyy) 1 Citp.3cly Nolo: If sprang on Dena of on Mil,. Nesse indcone the csoacq o vtorm SQ- 1-11(0 YCN aro slams ;foe examrk. Trustee. Ctel>0raktAncloalual Qytcior. tic INTERNAL 'USE Pax A0C-ifel NVTt0r O 2016 DeLfAcne Bank AG. NI rights meow."). WIA107679 ormigssisie Page A24 CONFIDENTIAL CONFIDENTIAL TOFED.R.CRIM. -PURSUANT P.6(e) DB-SDNY-00 GM_00189 SONY EFTA01357091