6. Meqya HapapKsritia/Place of birth KpaiHa/country USA 7. (———— 7) Tpanansancrea(u)/Garrent citizenship(s) American Kani Bei Manian rpamaqsmncrea(h), HasaBle MpaManIAHCTBA(b!), aKoe(in) Geno!) (_pelateteserensehonsommasatenanesinamelniinian dine) US Virgin Islands HyMap KBaTapei/apartment number B3 e-mail Jeevacation@gmail.com npahnpeiemcrea/company Southern Trust Company (STC) a-an3/pasition President so6nacye (paéi)/region US Virgin Islands eyniya/street Red Hook Quarters, B-3 racuiviya/hote Europe Hotel Minsk ix liypedenae Wpuranve vera GaN OUaial Opluaicn ofa purpose of visit Visting a sick friend EFTA00311310

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weet NA. sata Bisiry/purpose of visit NA ry Gacyars TOMS yes Tope wacoeare SuscIRarea/Previous Says Whe REDIDNC Of NA NA NA aryNibHed TOPMIM aCOBAra SHAXOAKAHHA/ mayne ear en NA is the agaregate term of temporary stay 6) a/from NA rafuntit NA (Cranoyuel agkas Ha MerTaHHe He ungse Aa aGaBAsKOBAal aQMOBe ¥ B>Yyjob! Ise, AAHAK y FITHIM BUIMAAKY NaxapaHa Bawa acaGicran NpeicyTHaqy 3 MaTAH Sahel eleellaatnos illo 19. GO NDAAyTnepKaHet p pune of ronarlort euaiabe for your anirarice to the Rapalile of Salers Boeing 727 Private Plano, Tall #NOOBJE. ing at Hotel Europe Boeing 727 Private Plane, Tall##N90BJE Means available for stay in the Republic of Belarus [sewahoss -oxloank heaves | sires, phone) United Healthcare, PO Box 740800, “atlanta, GA Npaxkeearve/accommodation canpayants s/valid from 01 11 2004 na/unti| NA 41. sxnapay»in/ Declaration A sanynaio, urro incbapmMaupia, akan 3MewyaHa ¥ raTai aHKeye, Jaynreyua AaknagHan | npaya3ieali. A senaw, wo naBefaMneHHe Henpayasietix apecrak anbGo agmajnenHe aq npagcrayneHHAa HeaGxopHbix AakyMeHTay MOKA Crykbilb mancraBsall ANA apMoBbt Ba Yeaase y Pacny6nixy Benapyce. 9 Taxcama nanapampKanbi, wTo, Kani raTan IMapmaubia Gya3e NpbIsHaHa HeAaknagHali, Bisa MOKA Sbilib ljaHynasaka ¥ moGbi MOMAHT. A aGaBazyioca na npHIGwuyi ¥ PacnyGnixy Benapycs Ba YcTeHoyneHbim napanKy adopmiyb paricrpaypiio | NaKivyUb AE TIPITOPHAO a JaKaHYIHHA TAPMIHY ABEAHHA Biab!. A NanApIKaHb! a6 HeaGxoAHacui Med Naqyac naeaAki MepbiUubIHcKyIO cTpaxoyky, Akasa agnasagae 3aKaHagaycrey Pacny6niki Benapyce / I declare that information in this application is true and correct. I am aware that any false statements or refusal to submit the necessary documents may lead to withholding a permit to enter Belarus. I am also warned that if this information is found to be incorrect, the visa may be cancelled at any time. On arrival to the Republic of Belarus 1 will register according to the established procedure and leave the territory of the Republic of Belarus before my visa expires. 1 am aware that during my travel I need to have a medical insurance that ements of Belarusian leq 04 08 2014 EFTA00311311

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20002-8591602 \ 8/3/2014 12:17:18 AM Completed: visa.kdmid.ru Destination: Consulate General of Russia in New York; i VISA APPLICATION (decors tra ol das Guar Wis torn k comatata and true. | am aware that any false statemenis will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under Russian law. | undertake to leave the territory of Russia upon the expiry of the visa If granted. | understand that possession of a visa does not entitle its bearer to enter Russia automatically. | will not seek compensa ** - not to be filled by holders of diplomatic and official passports on if | am refused to enter Russia. 1. Nationality (I! you formarty had USSR or Russian cilizenship, please indicate when and why you lost it) | 6. Purpose of visit UNITED STATES 2. Last name(as in passport) EPSTEIN 3. First and middle names (as in passport) JEFFREY EDWARD “away 20/01/1953 14. Passport No 516923892 tssued by US DEPARTMENT OF STATE BUSINESS 7. Category and type of visa COMMON BUSINESS 6. Number of entries Single entry | Double entry 9. Date of entry in Russia Multiple entry 10. Date of departure from Russia 20/08/2014 (daimevyy) Date of issue (saimmyy) 30/()6/2014 Valid until (ddtemyy) 29/06/2016 29/08/2014 (dairy) 73. Russian institution or organization to be visited? ('cr tursis — name and reference eumber of the host jours! company. for businessmen - name of the hosi organization and town, for private persons ~ last name, fesl name, middie names and home address of the hos!) MINISTRY OF ECONOMIC DEVELOPMENT OF RUSSIAN FEDERATION, , 1,3 1-YA TVERSKAYA- YAMSKAYA, MOSCOW “15. Do you have a medical insurance valid in Russia? yes XX Please specify? UNITED HEALTH CARE 76. Who will pay for your tripto and stay inRussia? Independently single (never married) XX divorced | 18. — full name {i divorced or spaated. please ncieale maiden name i applcaio) NA 20. Spouse's ——— I". Spouse's date of birth rm) NA **21. Your father's full SEYMOUR EPSTEIN “24. Has your passport ever been lost or stolen? *26. List all countries you have v’ the last ten years and indicate ~ the year of visit FRANCE, 28/03/2014; NORWAY, 28/11/2013; UNITED ARAB EMIRATES, 09/08/2011; TURKEY, 09/11/2010 | **22. Your mother's full name | PAULA EPSTEIN | 26. List all countries which have ever issued you a passport | NONE **27. List your last two places of work, excluding the current one 1.Name EPSTEIN INTERESTS Address 457 MADISON AVE, NYC, NY 10022 Your position CHAIRMAN Your position NONE Prone number Your chief's surname SELF Dales of joining - dismissal 01/2007 — (may) 07/2014 Phone number NONE Your chief's surname NONE Dates of joining - dismissal NONE (neniyy) (my) NONE — (my) EFTA00311312

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** - not to be filled by holders of diplomatic and official passports "28. List : all educational | institutions S you ever attended, except high schools Address and phone number ™" COOPER UNION 51 ASTOR PLACE NYC Course of sludy PHYSICS Dales of admission and graduation (9/1969 (amy) 06/1971 (amy) Address and phone number NONE Course of study NONE Dates of admission and graduation NONE = (mmyy) NONE — (amy) "29. List all professional, civil and charity organizations which you are/ **30. Do you have any specialized skills, training or experience were a member of or cooperate / cooperated with related to fire-arms and explosives or to nuclear matters, biological or NONE chemical substance? If yes, please specify NONE *31. Have you ever performed a military service? if yes, indicate the country, branch of service, rank, military occupation and dates of service NONE "32. Have you ever been involved in an armed conflicts, either as a member of the military service or a victim? If yes, please specify NONE 33. IMPORTANT! EACH APPLICANT MUST READ AND GIVE ANSWERS TO THE FOLLOWING QUESTIONS A visa may be refused to persons who are within specific categories defined by the law as inadmissible to Russia. Have you ever been arrested or convicted for any offence? yes X When? (sitrmyy) 20/07/2008 Where? FLORIDA, US Have you ever been afflicted with 2 communicable disease of public health significance or a dangerous physical or mentale,” al disorder? Have you ever been a abuser or a addict? ee Have you ever been refused a Russian visa? yes When? (atimnyy) Where? Has your Russian visa ever been canceled? yes When? (aamnyy) Where? Have you ever tried to obtain or assisted others to obtain a Russian visa or enter Russia by providing misleading or false Have you ever overstayed your Russian visa or stayed unlawfully in Russia? Have you ever been deported from Russia? . yes When? (daewmyy) Where? Your answer yes in item 33 does not automatically signify ineligibility for a visa. In this case you may be required to personally ppear before a consular officer. 34. Namo, address and phone number of a person or hotel in Russia that you plan to stay with ARARAT PARK HAYATT MOSCOW, 4 NEGLINNAYA STREET MOSCOW, RUSSIA, 109012, 35. Has this application been completed personally by you? If no, indicate the person completing this application in Item 36 36. Application completed: Sumame, first name ~ Relali ui Applicant's cat UNA oviress NA 37. Other names ever used (makien name, pen-name, holy orders, el.) NONE 38. Your permanent address, LITTLE ST JAMES, USV! l,l 39, Place of birth (if bom in Russie, please indicale when and what county you emigrated to) NEW YORK, USA yes X IO 40. Place of work or study, present position (name, address, phone and fax numbers. E-mail) | agree to my personal dats on this application ~“"N, 6100 RED HOOK SUITE B3, ST THOMAS, form being processed and communicated to the | appropriate Russian authorities for the issue of a visa. Date (daieruyy), applicant's signature g l qa MN ——— EFTA00311313