EFTA01460271.pdf

Pert 3 If Non-US Beneficiary/Non-US Beneficial Owner is an Individual: 1. I hereby certify that for the purposes of taxation I am not a tax resident in any country other than the country/countries indicated above. 2. I confirm that my ownership or other interest in the Entity, if any, is appropriately disclosed in accordance with applicable laws and regulations in the countries In which I em tax resident and may be required to be reflected in my tax filings. 3. I confirm that all Income or capital distributions received (or deemed to be received for tax purposes) by me from the Account(s) have been, and going forward will be. taken into account and included In my relevant tax fangs if required by the laws of the country (countries) of my tax residence. If Non-US Beneficiary/Non-US Beneficial Owner is an entity: 1. I hereby certify that for the purposes of taxation the non-US Beneficiary/non-US Beneficial Owner is not a tax resident In any country other than the country/countries indicated In this self-certification. 2. I confirm that my ownership or other interest in the Entity, if any, is appropriately disclosed in accordance with applicable laws and regulations In the countries in which I am tax resident and may be required to be reflected in my tax filings. 3. I confirm that all income or capital distributions received (or deemed to be received for tax purposes) by me from the Account(s) have been. and will be, taken into account and included in the relevant tax filings if required by the laws of the country (countries) of tax residence. I agree that Deutsche Bank may disclose this Certification and any other information related to it or the Account(s) now or in the future held with Deutsche Bank, to any relevant tax or governmental authorities of the country in which the ArrniiM(s) is/are/will be maintained or of any country in which I may be liable to pay taxes. I release Deutsche Bank from any obligations of bank secrecy, confidentiality and/or data protection under any applicable laws which might otherwise preclude the disclosure of such information. I acknowledge that the data protection laws of such other countries may not afford the information the same protections which h receives in the country in which the Account(s) is/&e/will be maintained. I understand that this waiver will remain In force until cancelled and notwithstanding cancellation It cannot be terminated retroactively. I declare that all statements made in this Self-Certification are, to the best of my knowledge and belief, nr:1 complete. I undertake to advise Deutsche Bank promptly of any change iny'rewnstearas of which I a are of and that causes the information contained herein to become incorrect an Certification within 30 days of such change in circumstances. Jeffrey Epstein Prnl Name of Signor Signature 04.28.2016 Onto (mm-clOYYVY) Capacity Note: If ,:going on behalf of en entity, ISOM* indicate Int capeoty In wench you ice signag (fa example Twee. Corpo(atertnamdual Wetter. etc.) INTERNAL USE ONLY: Account Nurnber(.): 0 2016 DOLAscho Bank AG. M rights reserved. VUNI167679 023811 041518 Page A2.2 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0121386 CONFIDENTIAL SONY GM_00267570 EFTA01460271