Epstein Secrets

otder^d to provide ail with respect to all the Account(s) to which this Self-Certification relates. contained srtSf^ch 30jlay firmations herein Jeffrey Epstein Print Name Signature 04-28-2016 Date (mm-dd-yyyy) Sole Member Capacity Note: Piease indicate the capacity In which you are signing the form (

ovide details of each Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Fii^t Name Last Name Jeffrey 01/20/1953 Epstein Controlling Person Type/Role Sole Member Date of Birth Controlling! Person ' EFTA01478353 Country/Countriss of Tax Reside

Controlling Person below. Please continue on a separate sheet if necessary (and attach to this form). Fii^t Name Last Name Jeffrey 01/20/1953 Epstein Controlling Person Type/Role Sole Member Date of Birth Controlling! Person ' EFTA01478353 Country/Countriss of Tax Residence US Virgin Island

ciary/non-US Beneficial Owner? Each Controlling Person who is also a non-US Beneflciarv/non-US Beneficial Owner must complete and sign Appendix 2; Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely in the United States is not required to complete and sign Appendix 2.

ontrolling Person below. Please continue on a separate sheet if necessary (and attach to this form). First Name jgffrgy Date of Birth Last Name Epstein Controlling Person Type/Role Owner 01/20/1953 Controlling Person Country/Countiies of Tax Residence US Virgin Islands is Controlling Person a

who the non-US Beneficiaries and non-US Beneficial Owners are. Jeepei^, Inc. EFTA01478366 Legal Name of Entity to which this Appendix 2 relates Jeffrey Epstein Non-US Beneficlary/Non-US Beneficial Owner Name 01/20/1953 Date of Birth/Oale of Incorporation (mm/dd/yyyy) Part 2 Tax Residency Country/Countr

Name of Entity to which this Appendix 2 relates Jeffrey Epstein Non-US Beneficlary/Non-US Beneficial Own

neficial Owner? Each Controlling Person who is also a non-US Beneflciarv/non-US Beneficial Owner must complete and sign EFTA01478365 Appendix 2; Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely In the United States is not required to complete and sign Appendix 2.

necessary (and attach to this form). atria Hama Jeffrey tau Nam•Epsteln Dote of Elrlh 1/20/1953 ConIzo

nernistymen-US Sanerntei Owner? Each Controlling Person who Is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign Appendix 2r Beneficiary/Beneficial Owner Self-Certification Form. A Controlling Person who is a Beneficial Owner with a tax residence solely in the United States is not required to complete and sign Appendix 2. N