EFTA01380935.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: Darren K. Indyke, Treasurer D. Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened: Gratitude America, Ltd., a U.S. Virgin Islands not-for-profit corporation and 501(c)(3) private foundation 6100 Red Nook Quarter, B3 St. Thomas, USVI 00802 c. The following information for each individual, if any, who, directly or indirectly, through any contract. arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name Date of Binh Legal Address For U.S. Persons For NOn•U.S. ;Persons: Social Security ;See footnote,. for eternal/vest Number to Social Security Number) Not Applicable For NomU.S. Persons. in addition toe Social Security Number or a Passport Number with Country of issuance, an alien identification core number. a number ono country of issuance of any other goveuerent•issued document eVit13.1eirbia rationality or residence and bearing a photcylapn or similar safeguard onould oe provide*. (If no kidividual meets this dr:Mill:A please write -Not 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 • My other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). Name Date of Birth I Legal Adelela For U.S. Persons: For Non-U.S. Persons: Social Security (Se* footnote 1 for alternatives{ Number to SootalSecurity Number) • 2 Kean Court, Livingston, NJ 07039 Darren K. Indyke For Noull.5. Persons. in 4o:titian to a Social Security. Number ore Passport Number with Country of Issas:tot, an ..IWn identification card number. or number and cantor of issuance of any other government-issued document egioentIng narronahty or residence she bearing a pirologrash or similar safeguard Shaul° oe cmvieleC. Darren K. Indyke (name of natural person opening the account), hereby certify, to the best of my knowledge, that the information prq sided above is complete and correct. Signature August 15, 2018 Segfigule Date /sic- ' . Na nt): 153-461 47/// t Legal Entity Identifier (Optional) Ve...ri•hcz) 7 yell Title: of $r 201S Detasolia Bank AG. Al) nr,pfis tesermo. Vet.i1E9666 0268,g to 29.05191?-11151 Date: glib It p CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0079514 CONFIDENTIAL SDNY_GM_00225698 EFTA01380935