EFTA01460221.pdf

Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must be completed for each Controlling Person of the entity, but only if the entity has a tax residence outside the United States. Please refer to the attached Guidance to the Entity Self-Certification Form which provides assistance for you to determine the Controlling Persons and how to complete this Appendix. Please provide details of each Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Fos Name Jeffrey Lao Name Epstein Dal° or Beth 01/20/1953 C°^" Img Pecs" r s'Pef" ° Pres., Dir., Ben. Owner Nonni?Igng. CountryCouMrles of Tax Residence Potion US Virgin Islands Is Controlling Persona non-US Bonentiary/non•US Elenermal Ownee? ✓ Yes room** 4/M00ot 2) NO Darren Last Name i nctyke Fall Da" or Bl Colenallmg Person TYPailalala Treas., Secy., Director Dm° Contrournal CountAlCountress of Tax Residence Purrom US Is Conirchng Person a non-US Yes (complete Appendix 2) ./ No Seneficeryrna,US Denefidel Owner? Fist Nalaa COC110 Laal N." de Jongh of Beef n.nwu nnn Controlling Person TYPellaale Director "e Cent, Comb-nrCounties or Tax Residence Penton US Virgin Islands Is Controlling Person a non-US Benerciaryfnen-US Elenefoar Oa? Yes (complete Appends 2) ✓ No first Name Last NAOMI! Dale of Oft Comrolling Parson Type:Rae Conlog! Couney/Countries of Tax Residence Perrion Is Connoting Persona non-US BonoltiarrabUS Berrettas' Canner? Yes (cemplele Appendix 21 No Pest Herne Lost Name Date of Birth Cannoning Person Traeger° Conirotir Pp' Ccuntry/Countnes of TeX Residence Person Is Commiling Person a non-US Yes {complete /wonder 2) No BenenciaryMoAUS Benda:el Owner? Each Controlling Person who Is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2: Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who Is a Beneficial Owner with a tax residence solely In the United States Is not required to complete and sign Appendix 2. INN 161679 023611 041516 Page At CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0121285 CONFIDENTIAL SONY GM_00287489 EFTA01460221