Full Legal Corporate Name: LLC Primary Corporate Address (No P.O. Box address. Must be a physical address.) Name: LLC Attention: Address Line 1: Address Line 2: City: State: Province: Postal/Zip Code: Country: UNITED STATES Tax ID a: 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 LLC Operating Agreement evidence state of domicile? Articles of Incorporation, Partnership Agreement, etc NY Introduction / Financial Information Introduction Type: Related Client A/C Specific Information: Jeffrey Epstein (Please identify referral source, etc.) Have you met with the Principal/Authorized Individual? C Yes 4- No If you did not meet with the Principal/Authorized Individual, please indicate why you have not met and when you will. Legal Entity: I have not met with Ms. Maxwell but know her advisor, Jeffrey Epstein. Jes Staley has met with Ms. Maxwell. Limited Liability Corporation What is the purpose for forming the LLC? Limited Liability Company The account holds Ghislaine Maxwell's NY residence and is used to pay real estate taxes and operating expenses. Princpal Beneficial Owner(s)/Shareholder(s) dentify the principal beneficial owner(s)/shareholder(s). If the entity is owned by an intermediate legal structure e.g. LLC or Partnership), list the ul imate individual beneficial owner(s). A beneficial owner s any person on behalf of whom the account is maintained. Last Name: First Name: % of Ownership SSN DOB Form of Govt Issued ID Obtained Citizenship Maxwell Ghislaine 100 Passport UNITED STATES Source of wealth of the beneficial owner(s)/shareholder(s): Source of wealth of the Partners: Other Other (Provide detailed and specific information) Upon opening her account, Ms. Maxwell Indicated that she is a real estate professional in NY. She is also the daughter of the late Rob