Epstein Secrets

(Exactly as it should appear on labels): K Mr. K Mrs. K Ms. K Miss K Dr. K Other Telephone number Fax number Residence (if an individual) or Principal Place of Business (if an entity) Address (Non Boxes Please, if any): Telephone number Fax number Attention: E-Mail Address: DOC ID - 26358443.8 12 EFTA00803571

ation K Foreign central bank of issue (not wholly owned by the foreign sovereign) K Foreign tax-exempt o ganization K Foreign private foundation K Government of a U.S. possession 4 Chapter 4 Status (FATCA status): K Participating FFI. K Reporting Model 1 FFI. K Reporting Model 2 FFI. K Registered deem

ferent) Street Address Line #2 (if different) City State ZIP Country Phone Fax Primary Email State and Country of Organization (entities only) Principal Place of Business (entities only) State and Country of Residency (individuals) Wire and Check Delivery Instructions for Distributions Please provide wire and/or c

K Insurance Company K Investment Company Registered with SEC K Broker-Dealer K Private Fund K Bank Holding Company K Private Foundation K 501(cX3) K Government Pension Plan K Foreign Investor K Other 1. Accredited Investor Status. The Investor is an "accredited investor" (within the meaning of Rule 501 und

(Exactly as it should appear on labels): K Mr. K Mrs. K Ms. K Miss K Dr. K Other Telephone number Fax number Residence (if an individual) or Principal Place of Business (if an entity) Address (No P.O. Boxes Please, if any): Telephone number Fax number Attention: E-Mail Address: DOC ID - 26358443.8 12 EFTA00604

ation K Foreign central bank of issue (not wholly owned by the foreign sovereign) K Foreign tax-exempt o ganization K Foreign private foundation K Government of a U.S. possession 4 Chapter 4 Status (FATCA status): K Participating FFI. K Reporting Model 1 FFI. K Reporting Model 2 FFI. K Registered deem