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PRINCIPALSD NEFICIALOWNERS: Prineipataknefanl chum el Name: Fina: BOB ntiwklniu Lac SOLARI MSN: s:O++mhip: rite: CHAIRMAN Ilwme Address: City: State: Zip: 1Lte elitists: Deme Phone. - - DLa / Sur. Equi Mdse.: - - - - PrineipFllecficiit Outlet a2 Now: Fin: _ Middle tit: Lar: SS•d: %Onurship: 7k: Norm Address. State: - Zip: Date of Birth:• Dome: - DIA / Stale: . Email Address Donn la PtiteiNMcui&ial (hate ad Nmtr. _ - - Fin: hfddle hit: Lan: - SSN: %Onnersldp: rale: - - lime M ims _ _ City: - Slate: lap: _ - _ late of Bette lime Phone: - DIA/State: - Email Mitres,- RinequYRrnefieial Onvter de Name: Fast: - - Middle hit lest SRN: %On n1flp: Title: lime Address: - - _ City: - _ State•. - - Zip: Mar of Binh now Roc: - - DU / Sale: _ - Flail Mire,' Centro0hag Mdtionnktefavi OnmName: Coonofutg itaeteal:: I 0 Yes f 0 No First BOB Middle Ink: tan: SOLARI Stu: - - xaaerahip: Tide: CHAIRMAN lime Address _ _ City: _ State Zip: Date of Birth: Nome Phone: DIA1 State. - - - Email Address: CERTIFICATION OF BENEFICIAL ORT ER(S) To help it government fight financial clime. Federal regulation sequin= certain financial instimions to obtain, verify: and Mond information about the beneficial coons of legal entity customers. Lepel entities can be abused to disguise involvement in terrorist fimrcing. morcy lsmdcring, tan evasion. comnptiot, fraud, and other frtmr6l crimes. Requiring the disclosure of toy individuals who own or control a legal entity Ite_ the beneficial owners) helps bon enforcement inrrinte and pnoneeme these crimes. By signing below. 1 attest that I hilt accurately provided the non:. address. date ofbinil and Social Smutty Ntmd,co ISSN) for the following'Wisidoals (i.e. the benefdal owners): ti) Each individual. if any. who owns directly or indirectly. 25 percent or more of do equity interests of the legal malty customer le g.. each renal person dui owns 25 potent or more o(tic shares ofacogoalion): pal (ill An indis idmd nth significant responsibility for managing Be legal entity anomer (e.g. n Chief Ems -nine ORav, Chief Finmrial ORrser. Chief Operating Offoer. htamgirre Member. General Panne President. V. President. or Trauma The number of indniduals that satisfy this definition of 'beneficial owner 009 vary. Under section (l, depending on 11c factual cirtommences. up to four individuals Mut as fen as rem) may need to be identified. Regardless of the muobcr of indh-idoMs identified under seedon (it you muss proide the idemifyitm information of arc individual miler section (11). It Is possible that in sone ei.cumstanets the same indisidsd nnigbi be ldendied under both unions (e.g.. the President of Acme. Inc. nit also holds a 50^: equity itaensl). Tan; a completed form will contain Ibe identifying infomntion of m hast one individual (under section Id)), and up to five ind'niduals Re. OTC iMnidal under section (iii and fou 25 paean equity holders under section (i)1. 1, the nodaos gnri _ ) ,edify that all of the information furnished above with retard to Information for p}j ladhidoal, B any. who directly or indirectly. thnoints on contract. arri00rmenl, understanding. relationship or otherwise, owns 2S percent or more of the equity interests of the legal entity listed above k complete nod accurate. .ignalu re: Dale: - - - - --- -- 23