EFTA01460267.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). Firm Nem* Jeffrey Las/ Name Epstein Dal° °Ball 01/20/1953 C°^" Img Pecs" TYPef" ° Pres., Dir., Ben. Owner Corkin-4n'. CountryCouMnes of Tax Residence Potion US Virgin Islands Is Controlling Potson a non-US annofimaiyMon.US Banancial Ownee? ✓ Yes (comp** Appendix 2) No Last Name inctyke First Nam. Darren Date of Bit•..,•. Controlling Person TYPTIR°. Treas., Secy., Director Cone °gruel County/Coon/nets oh Tex Resedenoa Pereal. US Is Connoting Person a non-US Yes (complete Appendix 2) No SeneficktrynotrUS Denefic'el Owner? FmTi Nam. Cecile Lad Nast. de Jongh Controlling Person TYPeinc4a Director pa Contrislifitt CalititiCounties of Tax Res.donce Prlinen US Virgin Islands Is Controlling Person a non-US BeneAotaryfnenA/S13eneffusal Oa? Yes (complete Appends 2) ✓ No tag Name Last Neale Dale of Ruth CoMrolling Person Type:Rae COnto5I Country/Camtries of Tax Residence Parton le Cootroang Persona non-US Yes (ccelaiete Appendix he eenefidary/ran-U$ eeneectei Ovals& Pest Name Lost Name Date of SIM Coraraiing Person TyoefRolo Control!' ng Ccuntry/Countnes of TeX Residence ren.00 Is Controlling Poison a non-US BeneaciaryMoAUS Beide:el Owner? Yes /compleici Appends 2) No 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. WM161679 023611 041516 Page At CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0121379 CONFIDENTIAL SONY GM_00267563 EFTA01460267