Place of Birth (City & Stare if in the U.S.. or City & Country as it is presently known.) NEW YORK, NY 5. Social Security Number 6. Email Address (o.g.. my [email protected]) ■ 8. Mailing Address: Line I: StreetiRFD#. P.O. Box, or URB. [email protected] 7. Primary Contact Phone Number 6100 RED

zation. II the undersigned elects lo transmit ony such Instructions via lex (ireiuding desktou fax), via email or as an Image attachment to email (o.g.. as a PDF, TTF or other Image of such instructions), the underslgrwd understands and agrees that the undersigned boars the risk of loss arising Iro