EFTA01480631.pdf

Primary Corporate Address Name: HBRK Associates Inc. Attention: Richard Kahn Address Line 1: 457 Madison Ave. Address Line 2: City: New York State: NY Province: Postal/Zip Code: 10022 Country: UNITED STATES Tax ID 4 : Remember to collect W-8's or other applicable tax forms for each Jurisdiction. Business Phone: O- State of Domicile: NY Where is the Company Incorporated? What document did you obtain to Certificate of Incorporation evidence state of domicile? Articles of Incorporation, Partnership Agreement, etc Introduction / Financial Information Introduction Type: Related Client NC Specific Information: Jeffrey Epstein is a longstanding client (Please identify referral source, etc.) Have you met with the Principal/Authorized I Yes r No Individual? Legal Entity: Corporation Corporation What is the nature of the business operations? Consulting (Describe products and services offered, how long in business, etc. If this is an operating company, indicate appx. number of locations and appx. number of employees, list a website if available) Public or Privately owned? (if public, where privately owned traded?) Locations served? G Domestic r International Is this a cash intensive business or a business r Yes f• No that uses cash as its principal activity? (e.g. convenience store, restaurants, retail stores, liquor stores, cigarette distributor, vending machine operator, parking garage, any other business in which cash is its principal activity) Principal Shareholder(s): dentify the principal shareholders. If the entity is owned by an intermediate legal structure e.g. LLC or Partnersh p), please list the ultimate individual shareholder(s) on whose behalf the account is maintained. Last Name: First Name: % of Ownership: SSN DOB Form of Govt Issued ID Obtained Kahn Richard 50 drivers license Beller Harry 50 drivers license Is this an operating company? r Yes g No Confidential Treatment Requested by JPM-SDNY-00002836 JPMorgan Chase CONFIDENTIAL SDNY_GM_00272034 EFTA01480631