II. Certification of beneficial owner(s)
Persons opening an account on behalf of a legal entity must provide the foaming information:
a. Name and Tide of Natui ai Pelson tTh:.!, • •
re.C-Pb•ve- Er fete-, kfut.t,AAA% -cc('
NiMT* of t.egal Entity. Type c.-1 Legal . • .,, ess of Legg? EN;ty fo• Whet the Amount is Being Openett
. The foikming infemnati)n for each indivitlual, if any, who, thready ar ir.directly, through env contract arrangement.
understanding, relationship or otherwise, owns 25 percent or more et the equity interests of the legal entity listed above:
, or US Pbfor:Z fl); fity..11,S
!Sift ".:Otr. s, -% alt.yn.Ac
l..untwe Sockm Se.ofin.-!.1Jint.t,t;
TaM-tit L r Lt.n (i .t)(c-3
Yoe rt's,. ; ,e;o:)At. et 'fit f tO .10.041Se"..4 y Faint40 .44 ;Mort Sittrba with Co‘;rri Of ',MO:MO.)0 410 &zoos. nitd7Italff€ a *IMO!:
4f.f/ entlitire oe ir.u.:ParJo of 31, oche gc.weir.te.r.Istu-xf dcoonem eyitSmainq nanorohtv or oftlfienr* ono MOMig u plweagiKS! 01141'0'u sal fc *7,f atcnilc
1* pic..le4d.
ill no wkiregiiiat rtlert !ha 0nisrlitelti. ONO. Vidt0 '401kre.Sse..360.1
0. The toikming Information for one Individual with significant responsibility for managing the legal entity listed above,
such as:
• An executive officer or senior menage: (e.g.. Chief Exc-anive Officer. Chief Financial Officer, Chief Operating OrT,cf.n.
Managing Member, General Partner. President. Vice President. Treasurer); Or
• Any other Mdivit ue! who regulany performs sk.,Ilar function.
pf appropriate, an individual listed under section (c) Mauve may also be listed in thin section (W).
:).ao c.t birth tepi Atte.en kw VS. Anone..
:341:11,t+ Y.P. kotrmil I ice itegrer.i.ts
Joint*, r.* VC'S SICAteit, %.111tAq;
UgnetT E. 4it k.,‘ See ' gi t) 47
-4-
;Or .4..“11.5-S..Pdt—
...n. arAi. to a Z.4tr-A Sec !!iii ft %sport Norber CAzirro-y of ts-cinnw. ji 2r 4:pf
.,i4loaber paysther tt nure,xx
IWO CO:ofdr; of hilthifirstc of AM; orAvs l)(..eenirtnea.hi and &tate' twidenCcE)Illinar.Olite Or Ilife601.:t.1191 Wigan 2 004004Soli 04 IVN0444 Jalti:044 d ',hook)
be Ottroti.W.
(name oi natural person opening the account), hereby certify. to tne heat of
:omplete and correct.
0„, etc ir
legal faqir; leitolifier i0C00ran
2918 Caucache War.. ati. Fa oprm:feuf,t0 vrAIRD666 M31) 051Sla
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0071451
CONFIDENTIAL SDNY_GM_00217635
EFTA01375828