EFTA01345166.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: JEFFREY E. EPSTEIN, PRESIDENT b. Name of Legal Entity. Type of Legal Entity, and Address of Legal Entity for which the Account is Being Opened: J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC., A 501(cX3) PRIVATE FOUNDATION/USVI CORPORATION 6100 RED HOOK QUARTER, 83 St THOMAS, USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract understanding. relationship or otherwise. owns 25 percent or more of the equity interests of the legalarrangement. entity listed above: Name I Date of Binh Legal Address 1 For U.S. PerSOIS: he NcuoU.S. Persons: I Seel& Seourkir (See footnote .1 for :Perna:ma( • Number to Soda! Security felerrber) --- 4 I I, NOT APPLICABLE I,• i 1 I • NO:WAS.Personi. in addition CO a Social Sorority Numb."( or a Prop:et Plumpertvitn Country of fasuan‘A on alien dentificallon care number. Of "WM& anti country of nuance c1onY oilier Oneernmeng-fasted document eviChtkary iedonalay or lasidence and tearing a ahocoaropn or aimilw tabgraard gleiva3 be provided. (ft nairidandiral enacts this definnlon. ,,tease orate "No! AoPhoobfe•-) 0. 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 (Cl)). Name Date of Bird, I Lsool Address For U.S. Persons: I Fa F Non•U S. aerSOM Social i (Sea foomote a for alsunaorasi Noma.: ( to Social SeCcnty Numbs() i 6100 RED HOOK QUARTER, B3 JEFFREY E. EPSTEIN (1/20153 ST. THOMAS, USVI 00802 i • For Non-tf.S. Porsono in addition to a Soto( Security Numee: ut o Pasopart Number vat Courtly of Issuance. on alien kfuntificanon card number. or ramiber and country of is of any Oyler pCornorberarrarbed document ovIcarrtinp nebOnidity ar rairdente aid oteeeg a Oh01.0pralal or be Dravaibl. Pradr SelOarrara about FREY E. EP TEIN me of natural person opening the account). hereby certify. to the best of y knowledge, that tie info is complete and correct. Signatur SI Leper Entky Identifier (Optional) Title: Date: z srpifruta4 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0031351 CONFIDENTIAL SDNY_GM_00177535 EFTA01345166