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, makes payments on behalf of, or handles other financial transactions related to a Non- U.S. Bank, the Investor represents and warrants that: ( 1) the Non-U.S. Bank has a fixed address, other than solely an electronic address, in a country in which the Non-U.S. Bank is authorized to conduct banking activities;
Investor is acting as agent or nominee for a Beneficial Owner, please check the item that best describes the Beneficial Owner.) Please check one: K Individual that is a United States person— (or a trust of such a person) K Broker-dealer K Insurance company K Investment company registered with the SEC
, makes payments on behalf of, or handles other financial transactions related to a Non- U.S. Bank, the Investor represents and warrants that: ( 1) the Non-U.S. Bank has a fixed address, other than solely an electronic address, in a country in which the Non-U.S. Bank is authorized to conduct banking activities;
Investor is acting as agent or nominee for a Beneficial Owner, please check the item that best describes the Beneficial Owner.) Please check one: K Individual that is a United States person— (or a trust of such a person) K Broker-dealer K Insurance company K Investment company registered with the SEC
non-U.S. financial transactions on behalf of the senior foreign political figure. ADW CAPITAL PARTNERS. L.P. 12 CONFIDENTIAL EFTA00314789 (1) the Non-U.S. Bank has a fixed address, other than solely an electronic address, in a country in which the Non-U.S. Bank is authorized to conduct banking activities;
ethod of communication: ❑E-mail ❑Fax ❑Regular Mail (Please use additional sheet, if necessary) • CATEGORY OF INVESTOR (Please select only one) K Individual U.S. Person (including his/her trusts) K Individual Non-U.S. Person (including his/her trusts) K Broker-Dealer K Insurance Company K Investment
Entities connected to both the Non-U.S. Bank and K Individual

United States
LOCATIONthe District of Columbia
LOCATION
Luxembourg
LOCATION
Belgium
LOCATION
Ireland
LOCATION
Denmark
LOCATIONthe Control Securities
ORGANIZATION
Finland
LOCATION
New Zealand
LOCATION
Norway
LOCATIONthe Securities and Exchange Commission
ORGANIZATIONthe Investor's Capital Contributions
ORGANIZATIONthe OFAC Programs
ORGANIZATIONK C Corporation
ORGANIZATIONthe "Wiring Bank
ORGANIZATIONCoverdell ESA
PERSONKeogh
ORGANIZATIONForm PF
ORGANIZATIONthe Beneficial Owner
ORGANIZATIONBanks, Savings and Loans and Similar Institutions
ORGANIZATION