EFTA01379574.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: JEEPERS, INC., A USVI CORPORATION 6100 RED HOOK QUARTER, B3 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: Date of Beth Legal Address For U.S. Persons: For Nort.U.S. Parsons: Secret Slcuray (See (OotriON for alternatives/ Number re Social Security Number) 6100 RED HOOK QUARTER, B3 JEFFREY E. EPSTEIN 1/20153 • ST' THOMAS, USVI 00802 I For Non-U.S Persons. et audition to a Social Security Number or a Passport Number ‘bitn Country of ;source. an alien identification card Tweeter, or numbed arc country of osuatioe of toy other government-issued clowment evicieleing rtatimarity or resecence and be prOlteed. boartc a Photograph Or sinaat saki/raw() VlOokl (If no inclnioual moots tbis definition. please ‘wile Not Appliee ran 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 (a)). Name Gate OT Sinn I Lego( Address For U.S. Persona: For Non-US. Parsons: Social Seamy/ (See femmeI for alternatives I Number to Seel( Seamy Number) - 1ABOVE JEFFREY E. EPSTEIN j SEE • Fr Non-US. Persons. in addition to a Social Security Number or a Panp,xt Number WWI Country of Issuance. and country of Issuance of any other goyarnnvel-isaurtd document evrclanc;no nationality ce resdence an arca letntrfcanco card :simper. or rambe and bearing a obeli:oh uh ce 'knee, saregvare thou' be ;tasked. (name of natural person opening the account), hereby certify to the best of ded above is complete and correct. Signature Verific r Name (Print tent Enift Identifier tOpixino. Title: oN. 51,044c Cpc CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0077179 CONFIDENTIAL SDNY_GM_00223363 EFTA01379574