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on if sou are: • An ritividual vita a s U.S. dean or U t resident also, • A ponnentm. corporation. co pay. or 23600=M4101.2•41O or copanced in the United Slates or wider tie laws of Ow wed States. • On state (other then a fryer estate). or • A dorrests aura (as defined In Regulations section 301.77014). &W
ng codes identify payees that are exempt from reporting under FATCA Those odes eddy TO Perecro submterg this form for accounts mane-amid outside a the United Stabs by croan foreign Marxist Inst.:Wont Therefore. rt you we only submitting tros form fa an accent you hold in the Urinal Saab. you may leave this hel
ign gorwrinere or any ce its potecal subdrosicess. agencies, a insbumentalites 5-A corponsron 8-A dealer en wrote or commode's reused to reader in the United States. the District of Ccorombe. or a possession of the !Triad States 7-A Wes canmssion merchant registered with the Commality Fttwes Teeing Crones-ton
eeded to determine whether the Partnership may accept an investor's investment, it is necessary for the investor (the "Subscriber") to complete this Questionnaire. Please answer all questions. Write "N/A" if not applicable. A. PLEASE PROVIDE THE FOLLOWING INFORMATION. 1. (a) Name of the Subscriber: (b)
egral role in helping to establish the Epstein Victim's Compensation Fund, which was one of the largest and most successful claims fund programs in U. S. history. Ms. Henderson has been recognized repeatedly as a "Rising Star" by SuperLawyers and annually by the National Trial Lawyers Association's "T
as the mediator in connection with the proposed settlement of the above- referenced action, entitled Jane Doe v. JPMorgan Chase Bank N.A., pending in the United States District Court for the Southern District of New York. 6. I have set forth my background as a mediator to provide context for the comments that foll
5.4 For the avoidance of doubt, should the Claims Administrator have concerns as to the accuracy of a Participating Claimant's claim form answers, Questionnaire answers, allegations, or any other information submitted, the Claims Administrator shall promptly notify Class Counsel in writing of those concerns
their insurers and reinsurers. 4.3 All Class Members who apply for an Allocated Amount will submit an additional release form included within the Questionnaire and Release. 5. Evaluation of Claims, Plan of Allocation, Final Awards, Supervision and Distribution of the Settlement Fund, and Reversion 5.1 T
egal, valid and binding obligation of the Investor, enforceable in accordance with its terms. If the Investor lives in a community property state in the United States, either (i) the source of the Investor's Capital Contribution will be the Investor's separate property and the Investor will hold the Interest as it
uch person should complete a separate Questionnaire for Individuals. If the subscriber is a husband and wife subscribing as joint tenants, only one Questionnaire is required. (ii) Questionnaire for Trusts (attached as Exhibit B-2). The Questionnaire for Trusts must be completed by any subscriber that is a t
Entities connected to both United States and Questionnaire

Jeffrey Epstein
PERSON
George W. Bush
PERSONthe Southern District
LOCATIONLeon Black
PERSON
Prince Andrew
PERSON
Alan Dershowitz
PERSONJane Doe
PERSON
Kenneth Marra
PERSON
Bradley Edwards
PERSON
Scarlett Johansson
PERSONJack Goldberger
PERSONDarren Indyke
PERSONMaria Farmer
PERSON
Virginia Giuffre
PERSON
Samantha Power
PERSON
Paul Cassell
PERSON
A. Marie Villafana
PERSON
the United States District Court
ORGANIZATION
Stephen Hawking
PERSONRoy Black
PERSON