Epstein Secrets

torney Tax ID / SSN: Current Empbyer Kellerhah Ferguson Krobin PUG Poston/Mk/Rant Address of errpbyer

ets Control (CfAC)? a Does the dent or related party have any financial or other association/ Interactions within high risk o yes 2 too countries? I. Corporate Documentation Attached (legal Entities Only) 0 yes O No O Not Applicable J. tindiscbsed Principal Form Complete (Intermediaries Only) O Yes O No 0 Not Applicable K. If

rney Tax ID/ SSN: Current Employer. Ketterhals Ferguson Kroblin PLLC Postion/Title/Rank: Attorney Addr

Control (OFAC)? Does the dent or related party have any financial ix other association! interacbons within high risk I—I H. Yes 2 No countries? I. Corporate Documentation Attached (Legal Entities Only) El Yes O No O Net Applicable 3. Undisclosed Principal Form Compiete (Intermediaries Orgy) O Yes O No 2 Not Applicable IC If

ney Tax ID / SSN: Current Employer: Kellerhals Ferguson Krohn PLLC Poston/Title/Rank: Attorney Address

(OFAC)? H Does the client a related party have any financial or other association/ interactions within high risk r❑L...I i Yes PI No countries? I. Corporate Documentation Attached (Legal Entities Only) El Yes O No O Not Applicable J. Undsdosed Principal Form Complete (Intermediaries Only) O Yes O No 2 Not Applicable K. If L

SSN: 074-72-9603 Current Employer. Ketterhals Ferguson Kroblln RIX Posten/Title/Rank: Attorney Addres

Control (OFAC)? H. Does the dent or related party have any financial or other association! interacbons within high risk LJI—I Yes 2 No countries? I. Corporate Documentation Attached (Legal Entities Only) El Yes O No O Net Applicable 3. Undisclosed Prince:el Form Compiete (Intermediaries Orgy) O Yes O No 2 Not Applicable IC If

llerhals - 00000499664 USA Attorney Kellerhals Ferguson Kroblin PLLC Tax ID / SSN: Position/Title/Rank:

n Assets Control (OFAC)? H. Does the client or related party have any financial or other association/ interactions within high risk countries? I. Corporate Documentation Attached (Legal Entities Only) J. Undisclosed Principal Form Complete (Intermediaries Only) A Yes No Yes A No Yes A No Yes A No A Yes Yes No Not App

Viroin Islands U.S. U S. Attorney Kellerhals Ferguson Kroblin PLLC Date of Birth: Country of Citizens

eign Assets Control (OFAC)? H Does the client or related party have any financial or other association/ interactions within high risk countries? I. Corporate Documentation Attached (Legal Entities Only) ittf! Yes No Yes A No Yes A No Yes A No ip Yes No Not Applicable https://dbforcepb.my.salesforce.com/servlet/servlet.I