Primary Corporate Address Name: Air Ghislaine, Inc. Attention: HBRK Associates Address Line 1: Address Line 2: City: New York State: NY Province: Postal/Zip Code: 10065 Country: UNITED STATES Tax ID # : Remember to collect W-8's or other applicable tax forms for each Jurisdiction. Business Phone: O- State of Domicile: Where is the Company Incorporated? What document did you obtain to Certificate of Incorporation evidence state of domicile? Articles of Incorporation, Partnership Agreement, etc DE Introduction / Financial Information Introduction Type: Related Client NC Specific Information: Jeffrey Epstein Introduced Ghislaine Maxwell to the firm. (Please identify referral source, etc.) Have you met with the Principal/Authorized Individual? Yes C No Legal Entity: Corporation Corporation What is the nature of the business operations? (Describe products and services offered, how long in business, etc. If this is an operating company, indicate appx. number of locations and appx. number of employees, list a website if available) Public or Privately owned? (if public, where Private traded?) Locations served? 5-corporation that holds private aircraft. 6. Domestic r International Is this a cash intensive business or a business that uses cash as it's principal activity? (e.g. convenience store, restaurants, retail stores, liquor stores, cigarette distributor, vending machine operator, parking garage, any other business in which cash is its principal activity) Principal Shareholder(s): dentify the principal shareholders. If the entity is owned by an intermediate legal structure e.g. LLC or Partnersh p), please list the ultimate individual shareholder(s) on whose behalf the account is maintained. Last Name: First Name: % of Ownership: SSN DOB Form of Govt Issued ID Obtained Maxwell Ghislaine 100 Dtiver's License r Yes F No Is this an operating company? r Yes a No Entity/Client Net Worth: $ 20.00 (U