EFTA01362294.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: Darren K. Indyke, Treasurer b, Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: I Gratitude America, Ltd., a U.S. Virgin Islands not-for-profit corporation and 501(c)(3) private foundation I 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 Date of Birth Legal Address For V.S. Persons: For Nal-US. Fermis: Social Security (See Immo:el for alternatives' Number to So6al Semeity Number) Not Applicable 1 For Nen-U.S. Persons. in 00Chhal to a Social Security Number ore Paieeport Number with Country of leathers* an and counny of taktanC4 of any other government.issued document evidencing nationality of residence and bearingalien identificationodd number, or hernber a cewitograpti or Barad set:guard should be prciftec, (if no individual meets this dolinitlivi Mecca Mite 'NM Aaa4Caal0.1 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)). Name DO:a of 84th Lea Adecess For US. Persons: i For Non-U.S. Persons: Social Security (See footnote 1. for altar:views! ' Number I to Social Seemly Number) 2 Kean Court, Livingston, NJ 07039 Darren K. indyke 02/18/1985 For Non-U.S, Pe sons. inmidden to a Social Security Number ore Passport Number yeah Canny of issuunctr, w alien and country of issuance of any other goverment-issued document v.:Centel notionality ce residence and beering identificatson card number, or number be nrcvioed. a photograph or similar safeguard skald Darren K. Indyke I. (name of natural person opening the account), hereby certify, to the best of my knowledge, that the information p ided above Is complete and correct. August 15, 2018 Signature Date Legal Entity Identifier (OpliOntli) 02016 Deutsche Dank AG. Al Fights reserved. 94818.5666 026819.051318 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0051656 CONFIDENTIAL SDNY_GM_00197840 EFTA01362294