EFTA01370175.pdf

Entity Self-Certification Form Appendix 2: Non-US Beneficiary/Non-US Beneficial Owner Self-Certification Form Deutsche Bank AG and its affdiates (collectively, 'Deutsche Bank') collect certain information, Including tax related Information, from their clients. Deutsche Bank collects this information to comply with certain local and international regulatory requirements that are designed, among other things, to foster and support a tax compliant environment. Although these requirements are not necessarily imposed by all countries, Deutsche Bank, as a global bank that strives to achieve consistency in its practices among all of its regions, nonetheless requires this information be provided by clients even If not required by regulation. Accordingly, Deutsche Bank Wealth Management Americas is writing to clients and sending you this Self-Certification to complete. As a Non-US Beneficiary/Non-US Beneficial Owner of AcceuM(s) with Deutsche Bank Wealth Management, you are required to state your residency (or residencies) for tax purposes. While Deutsche Bank Wealth Management does not provide tax advice. you may contact your Relationship Manager if you have questions concerning the Self-Certification process. If you have any questions about how to complete this Self- Certification or about how to determine your tax residency status, please contact your tax adviser or local tax authority. Entity Account Holder: please insert the Legal Name of Entity in #1 of Part 1 below and provide this Appendix 2 to each Non-US Beneficiary/Non-US Beneficial Owner, collect the completed certification and rearm It to your Deutsche Bank Relationship Manager. Appendix 2 is the "Non-US Beneficiary/Non-US Beneficial Owner Certification. This Appendix must be completed and signed by each non-US Beneficiary and non-US Beneficial Owner of the entity, regardless of whether such person Is a Controlling Person disclosed In Appendix 1. The attached Guidance to the Entity Self-CertlficatIon Form provides assistance for you to determine who the non-US Beneficiaries and non-US Beneficial Owners are. Mort, Inc. Legal Name of Entity to which this Appendix 2 teem Jeffrey Epstein rwm..ts BeneficiaryThon-US Beneficial Owner Name 01/20/1053 Dale of Birth/Dele of Incorporation (mnYttcllyYYY) Country/Countries of Tax Residence US Virgin Islands If you have additional countries of tax residence. please attach a list of additional countries of tax residence to this form. WLII67679 023611.0415103 Page A2-1 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0062813 CONFIDENTIAL SDNY GM_00208997 EFTA01370175