n TwieRole Beneficiary No Yes (complete Append* 2) Fes Name ca ne La g NW/. Dubin DateatBirth3/31/1995 CouttyCountries of Tax Residence US Is Convolimg Persona non-US Beneficiary/non-US Benefice' Omer? Each Controlling Person who is also a non-US Beneficiary/non-US Beneficial Owner must complete and sign