EFTA01345288.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). First Nam*. Lest Nacre_ Data of Bret conlfeanc Felfor TPPRee President Cedniferrourcaes of Tax Rawdense US Is Contrclling Person a non-US Beneficaryinon-US Beneficial Owner? Yes fcomrdote Append& 2i J No First Name J e ffr ey La" Nora Epstein Dale of Binh Cm/I.:ding Ps3" TYPRIfin'" Director CdtaNYCOuntAn of lax R4140€04, US Virgin Islands Is Controlling Person a non.US BeneficiarylneAUS Beneficial Owner' Yet (complete Appendix 2) pi No Feet Name= Last Nemo Data of BIM COrdrOttlog "MOP fyriemelfl Secretary, Director Countryfeountnes of Tax Perulence US Virgin Islands Is Controlling Person a non-US Yes (confiolete Adders* 2) pe No BeneeporytnorhUS Beneficial Owner? First Name Last Nate Dale of Seth Caw-eine Munn TrDotl°41Treasurer, Director CountrmteuntrIes of Tax Resallsece US Is Cmurofing Persona non-US Yas (complete Aw.nd 2) No BenoficeryMon-US Beneficial Owner? Felt Name Lath Hanle Date of Sidn Corstolling Renee tvaNfide Country/Counines of Tax Refidence Is Cadrolling Person a now US Yes (ccemlete Adoemfix 2) NO Beneficiary/non-US Bennactel Owners 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. wm167679 023filt 441516 Page Al CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0031545 CONFIDENTIAL SDNY_GM_00177729 EFTA01345288