EFTA01380837.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 Tine 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: J p6r`LAN 0, LLC, A USVI LIMITED LJABIUTY COMPANY 100 RED HOOK QUARTER, B3 I ST. THOMAS, USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangemen t understanding, relationship or otherwise. owns 25 percent or more of the equity interests of the legal entity listed above: Nome Date of Birth legal Address For U.S Person' For Non-U.S. Persons: I I Social Security (See footnote: for ofteinatives Number to Social Security Mantel 8100 RED HOOK QUARTER, B3 I JEFFREY E. EPSTEIN 1120153 St THOMAS, USVI 00802 I H I ' For Non-US. Persona in addition to a Social Security NtaAIW of a Passport Memo( with Country of Novara an and county of issuance of any other govammormiseued document oriels:fen nationality Oe tatacIONNI ellen identification card number. or number to provided. and taadog a la\atMartieh a Wa'aricaole9LfOra should (If no indivioual matt tnis definition. Weave of itio 'Not ArMlicablen 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)), Nome I Dam of Bath legatAtcaess For U.S. Persons: For Non4l S. Pinions Social SeatrAY (See footnote I for laanethattS Number to Social Security Number) i 'ABOVE JEFFREY E. EPSTEIN SEE L___ ' For Non-US. Persona in addition to a Social Security Nwmber or a Passport Nismber with Cmuntry of Issuance. an Oen identification card nuffair. or marker and country of issuance of any other government-issued document evidencing rationality or oesidenoe and blaring a photeemaa a rims be provided. safeguard should ural person opening the account), hereby certify, to the best of °rotation e is complete and correct. 7124H8 Date Legal Entity Identdier Motional! CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079398 CONFIDENTIAL SDNY_GM 00225582 EFTA01380837