DISCLOSURE STATEMENT
, hereby acknowledge that I am aware of the confidential nature of the
settlement agreement between [ initials ] and Jeffrey Epstein, stating that the amount of the
settlement shall be kept strictly confidential and shall not be disclosed by me to anyone. I am also
aware that if this confidentiality is breached by me, [ initials] may file a lawsuit against me in federal or
state court seeking damages, equitable relief, and attorney's fees and costs .
Dated this day of , 2009.
Name:
Address:
Signature:
EFTA00725589