Epstein VCP jGlairn II: EPSTEIN VCP Epstein Victims' Compensation Program For Victims-Survivors of Sexual Abuse by Jeffrey Epstein ATTESTATIONS/SIGNATURE PAGE (For Subm ission of Wet Signature) This portion of the Claim Form must be signed and notarized. The Epstein Victims Compensation Program cannot begin proc essing your claim until this form is submitted with the Claimant's orig inal signature and a notary signature and seal. I hereby certify that the information provided in this Claim Form and any documents provided in support of this claim are true and accurate to the best of my knowledge, and declare under penalty of perjury that the foregoing is true and correct. I understand that false statements or claim s made in connection with this claim may result in fines, imprisonment and/or any other remedy available by law, and that claims that appear to be potentially fraud ulent or to contain information known to me to be false when made will be forwarded to federal, state and local law enforcement authorities for possible investigati on and prosecution. I authorize the Administrator of the Epstein Victims' Compensation Program and her designees to use and/or disclose infor mation submitted as part of my claim for the purposes of processing and evaluating my claim , administering the Program and other Program -related work. such as the resolution of applicable Medicare and/or Medicaid liens, and reports to law enforcement where appropriate. Note: The claim file is not available for inspection, review, or copying by the Estat e, the Minutia or the Claimant's representatives. I agree that by participating in the Program, I urn using the services of a third-party administrator to help reach a resolution of my claim , and that the Program is entitled to confidentiality and protection from disclosure under applicable laws. For Claimants with an attorney or other authorized representative, the claimant and the attorney or other authorized representa tive must initi