EFTA01480735.pdf

Business Name: (To Record Individual's Ownership Or Employer) a Primary Address Business Address Addresses (Legal address on account) (Other than Primary Address) Name: Attention: Address Line 1: 2 Kean Court Address Line 2: City: Livingston State: NJ Province: Postal/Zip Code: 07039 Country: UNITED STATES UNITED STATES Legal Entity: Individual / Joint Industry Code: PRIVATE HOUSEHOLDS NAIC Code: 814100 Citizenship: UNITED STATES Date of Birth: 02/19/1965 (Use 4-digit year) Gender: Male Tax ID a: Remember to collect W-8's or other applicable tax forms for each jurisdiction. Passport/Drivers License #: Home Phone: O- Introduction Information Introduction Type: Other Specific Information: Darren Indyke Is the attorney for our client, Jeffrey Epstein. Met With Principal? Yes r No If you did not meet the Principal, give an indication of why you haven't met the individual and when you will. N/A What form of goverment issued Identification document did you obtain for the files? Driver's License Financial Information Occupation, Business or Employer Attorney of the Client: Net Worth of Client: S 3 (USD millions) Documentation/ Information Annual salary plus value of personal residence obtained to confirm stated net worth of the Client: Source Of Wealth: Executive Management/Professional Executive Management/Professional What is the client's current Attorney executive management position? (Include any former positions, If significant to source of wealth) List the number of years in 16 current position. (Include any former positions, if significant to source of wealth) Confidential Treatment Requested by JPM-SDNY-00002951 JPMorgan Chase CONFIDENTIAL SDNY_GM_00272149 EFTA01480735