Bank Virgin Islands Affidavit Lost, Stolen or Destroyed Savings Passbook or Certificate Jeffrey Epstein (customer name), declaring under oath, gives the following statement and swears that all of the statements below are true: I am the s I i r nd only lawful owner of: No. in FirstBank's the 8 day of 06 K Savings Passbook 0 Certificate Yacht Haven Grande Branch issued by that Bank on , 2010 . I have not disposed of this passbook or certificate, nor of my interest in the proceeds of this account. This K Passbook Certificate has been K Stolen K Destroyed 0 Lost K Other. If the Bank agrees to pay to me or to anyone I name, or to transfer , from the deposits that are represented by the passbook or certificate described above, then I agree to be responsible for any loss which the Bank might sustain from any claim for the deposits. I agree to repay the Bank any money which it may pay by reason of any such claim together with the Bank's costs, including attorney's fees. Any pronoun of feminine or neuter, instead of masculine, gender, and of plural, instead of singular, number herein stated are substituted wherever the context so requires. In St. Thomas , Virgin Islands , this 7 day of Affidavit Number: Signature Sworn and subscribed before me by , of old age, K Single K Married, resident of me personally known. In 'FiatBank Wain Islands is a diaiscin d FirtsBank Puerto Rico , this day of and to Public Notary PINNS-2035-0502 EFTA00313212