Epstein Secrets

medWeek) G Does the client or related party have any financial or other association / nteracuons within counvies Dyes 0 No or repines sanctioned by the Office of Foreign Assets Control (OFAC)? H Does the client or related party have any financial or other association/ interactions within Ngh rlsk O 1t 2 No countries? SDNY_GM_000

ide of his/her cony of rationality for 5 years a more? O yes 0 No Profession/Occupation: Attorney Tax ID / 5511: Current Employer: Kellerhals Ferguson Kroblin PLLC Positonfhtle/Rank: Address of employer: 9100 Pat of Sale Mall, Ste 15 St. Thanes VI Unted States 00802 Does the person work as senior execut

diately) Does the client or related party have any financial or other association / interactions r F G' within countries or regimes sanctioned by the Office of Foreign Assets Control (OFAC)? Yes No H. Does the client or related party have any finandal or other assoclabon/ interactions within high risk countries? r Yes F No I.

e: USA Country of Citizenship: USA Address of primary residence: Profession/Occupation: Attorney Tax ID / SSN: Current Employer: Kellerhals Ferguson Kroblin PLLC Position/Tide/Rank: Address of employer: Is the individual a Politically Exposed Person (PEP)?(if yes, descnbe) F Yes F No To the best of

nce immediately) Does the client or related party have any finanaal or other assoctation I interactions G within countries or regimes sanctioned by the Office of Foreign Assets Control D yes ['21No (OFAC)? Does the them or related party have any finanaal or other association/ interactions H .Yes No within high risk countries?

of hislher country of nationality for 5 years or more? Elves 10 No Profession/Occupation. Attorney Tax ID / SSN: Current Employer: Kellerhals Ferguson Kroblin PLLC Position/Title/Rank: Attorney Address of employer: 9100 Port of Sale Mall, Ste 15 St. Thomas Virgin Islands, U.S. 00802 Does the person wor

Does the client or related party have any financial or other association / interactions within countries Ll I—I Yes No or regimes sanctioned by the Office of Foreign Assets Control (OFAC)? Does the client or related party have any financial or other association/ interactions within high risk i_J I—I Yes g No H. countries? I.

e of his/her country of nationality for 5 years or more? 0 yes n No Profession/Occupation: Attorney Tax ID / SSN: Current Employer: Kellerhals Ferguson Kroblin PLLC Position/Title/Rank: Attorney Address of employer: 9100 Port of Sale Mall, Ste 15 St. Thomas Virgin Islands, U.S. 00802 Does the person wor

immediately) G Does the client or related party have any financial or other association / interactions within countries or regimes sanctioned by the Office of Foreign Assets Control (OFAC)? H Does the client or related party have any financial or other association/ interactions within high risk countries? I. Corporate Docume

ce: Profession/Occupation: Current Employer: Address of employer: Erika Kellerhals - 00000499664 Viroin Islands U.S. U S. Attorney Kellerhals Ferguson Kroblin PLLC Date of Birth: Country of Citizenship: Has client resided outside of his/her country of nationality for 5 years or more? Tax ID / SSN: Po