EFTA01460178.pdf

Appendix I Controlling persons (continued) How to complete this Appendix For each Controlling Person identified. please complete their details in the boxes provided. Please continue on a separate sheet if necessary and attach the sheet to the form and appendices. Field Guidance First Name Enter the full first name of the individual who is a Controlling Person Last Name Enter the last name of the individual who is a Controlling Person Date of Birth Enter the Controlling Person's date of birth including the year Controlling Person Type/Role Please enter the type of Controlling Person and their role based on the below indicative list: a. Controlling Person of a legal entity—control by ownership b. Controlling Person of a legal entity—control by other means c. Controlling Person of a legal entity—senior managing official d. Controlling Person of a trust—settlor/grantor e. Controlling Person of a trust—trustee f. Controlling Person of a trust—protector g. Controlling Person of a trust—beneficiary h. Controlling Person of a trust—other i. Controlling Person of a legal arrangement (non-trust)—settlor-equivalent j. Controlling Person of a legal arrangement (non-trust)—trustee-equivalent k. Controlling Person of a legal arrangement (non-trust)—protector-equivalent I. Controlling Person of a legal arrangement (non-trust)—beneficiary-equivalent m. Controlling Person of a legal arrangement (non-trust)—other Country/Countries of Tax Residence: Enter the names of all countries in which the Controlling Person is a tax resident. Is Controlling Person a non-US If the Controlling Person is also a non-US Beneficiary/non-US Beneficial Owner. Beneficiary/non-US Beneficial Owner? check the 'Yes' box. If not, check the 'No' box. See Section C: How to Complete Appendix 2 for definitions of Beneficiary and Beneficial Owner If you have checked the 'Yes' box, Appendix 2 must be completed and signed by that Controlling Person. WhI167720 023743.041516 Page 3 015 CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0121222 CONFIDENTIAL SDNY_GM_00267406 EFTA01460178